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Counselors, Hospitals, Treatment Centers

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STATE OF NEVADA

Psychiatric Residential Treatment Facility

Sparks, Nevada

Provider NPI: 1659448017

Organization Information:
Organization Name:  STATE OF NEVADA
Organization is not Subpart
Authorized Official:  MARTY  CARRAHER  ADMINISTRATIVE SERVICES OFFICER  775-6881658

Practice Location:
480 GALLETTI WAY  SPARKS, NV 89431 US
Tel: 775-688-1633  Fax: --

Business Mailing Address:
2655 ENTERPRISE RD  RENO, NV 89512 US
Tel: 775-688-1600  Fax: 775-688-1616

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y323P00000XResidential Treatment Facilities
Psychiatric Residential Treatment Facility

Other Provider Identifiers:

IssuerNumberStateType
100507984NV05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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