Provider Demographics
NPI:1093289928
Name:STATE OF NV AGING & DISABILITY SEVICES DIVISION- FE WAIVER
Entity Type:Organization
Organization Name:STATE OF NV AGING & DISABILITY SEVICES DIVISION- FE WAIVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SERVICES OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-687-2487
Mailing Address - Street 1:3416 GONI RD BLDG D
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-8008
Mailing Address - Country:US
Mailing Address - Phone:775-687-2487
Mailing Address - Fax:
Practice Address - Street 1:3416 GONI RD BLDG D
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-8008
Practice Address - Country:US
Practice Address - Phone:775-687-2487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization