Provider Demographics
NPI:1467265439
Name:SILVER STATE ADOLESCENT & TREATMENT CENTER LLC
Entity type:Organization
Organization Name:SILVER STATE ADOLESCENT & TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TER-HOVHANNISYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-928-0038
Mailing Address - Street 1:5850 CANOGA AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6750
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8225 W ROBINDALE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3701
Practice Address - Country:US
Practice Address - Phone:818-928-0038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children