Provider Demographics
NPI:1427884626
Name:ELKO BOYS & GIRLS CLUB INC.
Entity type:Organization
Organization Name:ELKO BOYS & GIRLS CLUB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-738-2759
Mailing Address - Street 1:PO BOX 2114
Mailing Address - Street 2:PO BOX 2114
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803
Mailing Address - Country:US
Mailing Address - Phone:775-934-4887
Mailing Address - Fax:
Practice Address - Street 1:782 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801
Practice Address - Country:US
Practice Address - Phone:775-738-2759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency