Provider Demographics
NPI:1053491977
Name:NEVADA TREATMENT CENTER
Entity Type:Organization
Organization Name:NEVADA TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-382-4226
Mailing Address - Street 1:1721 EAST CHARLESTON
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104
Mailing Address - Country:US
Mailing Address - Phone:702-382-4226
Mailing Address - Fax:702-382-4031
Practice Address - Street 1:1721 EAST CHARLESTON
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104
Practice Address - Country:US
Practice Address - Phone:702-382-4226
Practice Address - Fax:702-382-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2567NTC-13261QM2800X
NVRCE004-457324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV001702100Medicaid