Provider Demographics
NPI:1992134472
Name:ALTA VISTA MENTAL HEALTH LLC
Entity type:Organization
Organization Name:ALTA VISTA MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-624-8200
Mailing Address - Street 1:1201 TERMINAL WAY STE 217
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3258
Mailing Address - Country:US
Mailing Address - Phone:775-624-8200
Mailing Address - Fax:775-624-8222
Practice Address - Street 1:1201 TERMINAL WAY STE 217
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3258
Practice Address - Country:US
Practice Address - Phone:775-624-8200
Practice Address - Fax:775-624-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health