Provider Demographics
NPI:1447332382
Name:STATE OF NEVADA
Entity type:Organization
Organization Name:STATE OF NEVADA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-687-5162
Mailing Address - Street 1:1665 OLD HOT SPRINGS RD
Mailing Address - Street 2:SUITE 157
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0782
Mailing Address - Country:US
Mailing Address - Phone:776-687-5162
Mailing Address - Fax:775-687-1214
Practice Address - Street 1:320 N MOAPA VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:OVERTON
Practice Address - State:NV
Practice Address - Zip Code:89040-0000
Practice Address - Country:US
Practice Address - Phone:775-726-3377
Practice Address - Fax:775-726-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV30655Medicare PIN