Basic Information
| Provider Information | |||||||||
| NPI: | 1962595348 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPECIALIZED ALTERNATIVES FOR FAMILIES AND YOUTH OF NEVADA, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SAFY OF NEVADA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 10100 ELIDA RD | ||||||||
| Address2: | |||||||||
| City: | DELPHOS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458339056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196958010 | ||||||||
| FaxNumber: | 4196950004 | ||||||||
| Practice Location | |||||||||
| Address1: | 4285 N RANCHO DR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891303446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023855331 | ||||||||
| FaxNumber: | 7028945678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2006 | ||||||||
| LastUpdateDate: | 03/22/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HICKS | ||||||||
| AuthorizedOfficialFirstName: | VALERIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | STATE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7023855331 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MSSA, LISW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 251B00000X | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 006102507 | 05 | NV | MEDICAID | 100507947 | 05 | NV | MEDICAID | 100507948 | 05 | NV | MEDICAID | 100507953 | 05 | NV | MEDICAID | 100509297 | 05 | NV | MEDICAID | 9005042930 | 05 | NV | MEDICAID | 9005042922 | 05 | NV | MEDICAID | 9005042906 | 05 | NV | MEDICAID | 100507950 | 05 | NV | MEDICAID | 100507951 | 05 | NV | MEDICAID | 100509901 | 05 | NV | MEDICAID | 100507952 | 05 | NV | MEDICAID | 9005042914 | 05 | NV | MEDICAID |