Provider Demographics
NPI:1215305818
Name:LEVADA HOUSE LLC
Entity type:Organization
Organization Name:LEVADA HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARIELL
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:DIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-357-2623
Mailing Address - Street 1:550 N MCCARRAN BLVD
Mailing Address - Street 2:BOX 204
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-5278
Mailing Address - Country:US
Mailing Address - Phone:775-357-2623
Mailing Address - Fax:
Practice Address - Street 1:3905 CLEAR ACRE LN APT 27
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1283
Practice Address - Country:US
Practice Address - Phone:775-357-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20151522395322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children