MEDICARE: STATE OF NEVADA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1548350895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF NEVADA

Provider Business Mailing Address
First Line	:	ATTN: CYNDI SMITH
Second Line	:	240 S. HUMAHUACA
City	:	PAHRUMP
State	:	NV
Zip	:	89048-2199
Country	:	US
Telephone Number	:	775-751-7406
Fax Number	:	775-751-7409

Provider Business Practice Location Address
First Line	:	825 N 2ND ST
Second Line	:
City	:	BATTLE MOUNTAIN
State	:	NV
Zip	:	89820-2834
Country	:	US
Telephone Number	:	775-635-5753
Fax Number	:	775-635-8028

Authorized Official
Title or Position	:	AGENCY MANAGER
Name	:	ELLEN RICHARDSON-ADAMS
Credential	:
Telephone Number	:	702-486-4400

Provider Enumeration Date	:	10/14/2006
Last Update Date	:	11/14/2022

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Directions to “STATE OF NEVADA ” Practice Location

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