Basic Information
| Provider Information | |||||||||
| NPI: | 1811260094 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHERN NEVADA ADULT MENTAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 480 GALLETTI WAY | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894315564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756882001 | ||||||||
| FaxNumber: | 7756882192 | ||||||||
| Practice Location | |||||||||
| Address1: | 480 GALLETTI WAY | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894315564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756882001 | ||||||||
| FaxNumber: | 7756882192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2012 | ||||||||
| LastUpdateDate: | 02/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | O'BRIEN | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7756882001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | 652 | NV | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 005416864 | 05 | NV | MEDICAID | 100501303 | 05 | NV | MEDICAID | 001316864 | 05 | NV | MEDICAID | 100503395 | 05 | NV | MEDICAID | 001416864 | 05 | NV | MEDICAID | 002016864 | 05 | NV | MEDICAID | 1972501021 | 05 | NV | MEDICAID | 002816864 | 05 | NV | MEDICAID |