1962520239 NPI number — NEVADA HEALTH CENTERS INC

Table of content: (NPI 1962520239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962520239 NPI number — NEVADA HEALTH CENTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEVADA HEALTH CENTERS INC
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:
6
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:
1962520239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1802 N CARSON ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89701-1215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-888-6610
Provider Business Mailing Address Fax Number:
775-887-7046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2839 BURNHAM AVE
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:
89169-1793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-369-0679
Provider Business Practice Location Address Fax Number:
702-369-8227
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHASE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
775-887-1590

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , 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: 100505013 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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