Provider Demographics
NPI:1093303000
Name:NEVADA CRISIS INTERVENTION TEAM
Entity Type:Organization
Organization Name:NEVADA CRISIS INTERVENTION TEAM
Other - Org Name:NEVADA CRISIS INTERVENTION TEAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TENAYA
Authorized Official - Middle Name:NIKARA
Authorized Official - Last Name:FENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-927-5085
Mailing Address - Street 1:2406 MOROCCO AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0945
Mailing Address - Country:US
Mailing Address - Phone:702-927-5085
Mailing Address - Fax:
Practice Address - Street 1:2406 MOROCCO AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0945
Practice Address - Country:US
Practice Address - Phone:702-927-5085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ZAMIAYA HOME HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-05
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250009391Medicaid