Basic Information
| Provider Information | |||||||||
| NPI: | 1124219712 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHERAPY OF NEVADA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 W NYE LN | ||||||||
| Address2: | 102 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897031541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758849911 | ||||||||
| FaxNumber: | 7758849913 | ||||||||
| Practice Location | |||||||||
| Address1: | 680 W NYE LN | ||||||||
| Address2: | 102 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897031541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758849911 | ||||||||
| FaxNumber: | 7758849913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2007 | ||||||||
| LastUpdateDate: | 09/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | HAYES | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7754438302 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 100511791 | 05 | NV | MEDICAID |