Provider Demographics
NPI:1073078788
Name:SILVER STATE HEALTH SERVICES
Entity Type:Organization
Organization Name:SILVER STATE HEALTH SERVICES
Other - Org Name:SILVER STATE AT CORRIDOR OF HOPE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:LINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-471-0420
Mailing Address - Street 1:200 FOREMASTER LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-1008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 FOREMASTER LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-1008
Practice Address - Country:US
Practice Address - Phone:702-471-0420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SILVER STATE HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-06
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)