Provider Demographics
NPI:1962573931
Name:STATE OF NEVADA - DV MH DS SIERRA DEV CENTER
Entity type:Organization
Organization Name:STATE OF NEVADA - DV MH DS SIERRA DEV CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACTING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-688-1930
Mailing Address - Street 1:605 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-8100
Mailing Address - Country:US
Mailing Address - Phone:775-688-1930
Mailing Address - Fax:775-688-1950
Practice Address - Street 1:605 S 21ST ST
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8100
Practice Address - Country:US
Practice Address - Phone:775-688-1930
Practice Address - Fax:775-688-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty