Provider Demographics
NPI:1972501021
Name:STATE OF NEVADA
Entity type:Organization
Organization Name:STATE OF NEVADA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM AGENCY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LCSW
Authorized Official - Phone:775-688-3321
Mailing Address - Street 1:4150 TECHNOLOGY WAY
Mailing Address - Street 2:STE:300
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-2026
Mailing Address - Country:US
Mailing Address - Phone:775-684-4051
Mailing Address - Fax:775-684-5966
Practice Address - Street 1:480 GALLETTI WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5564
Practice Address - Country:US
Practice Address - Phone:775-688-0400
Practice Address - Fax:775-688-0434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV652HOS-14261QM0850X
283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV005416864Medicaid
NV001416864Medicaid
NV100501303Medicaid
NV100503395Medicaid
NVVN29400029400OtherMEDICARE/MEDICARE PIN
NV002016864Medicaid
NV001316864Medicaid
NV002816864Medicaid