1306022025 NPI number — WESTCARE NEVADA

Table of content: (NPI 1306022025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306022025 NPI number — WESTCARE NEVADA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTCARE NEVADA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306022025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94378
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89193-4378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-385-2090
Provider Business Mailing Address Fax Number:
702-924-2575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5659 DUNCAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89130-2811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-385-2020
Provider Business Practice Location Address Fax Number:
702-658-0480
Provider Enumeration Date:
01/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ORTBALS
Authorized Official First Name:
KEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
702-385-2090

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  N35000041112243 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100511279 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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