Provider Demographics
NPI:1083612741
Name:STATE OF NEVADA
Entity Type:Organization
Organization Name:STATE OF NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:S
Authorized Official - Last Name:BELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-332-6713
Mailing Address - Street 1:100 VETERANS MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005
Mailing Address - Country:US
Mailing Address - Phone:702-332-6713
Mailing Address - Fax:702-332-6762
Practice Address - Street 1:100 VETERANS MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005
Practice Address - Country:US
Practice Address - Phone:702-332-6713
Practice Address - Fax:702-332-6762
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA STATE VETERANS HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-07
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2984 SNF-6311500000X, 313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1902320Medicaid
NV1902320Medicaid