Provider Demographics
NPI:1316368673
Name:SOUTHERN NEVADA HEALTH DISTRICT
Entity type:Organization
Organization Name:SOUTHERN NEVADA HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:702-759-0930
Mailing Address - Street 1:400 SHADOW LN
Mailing Address - Street 2:STE 208
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4363
Mailing Address - Country:US
Mailing Address - Phone:702-759-0930
Mailing Address - Fax:
Practice Address - Street 1:400 SHADOW LN
Practice Address - Street 2:STE 208
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4363
Practice Address - Country:US
Practice Address - Phone:702-759-0930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN23003251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRN23003Medicaid
NV163WC1500XMedicaid