Provider Demographics
NPI:1114309432
Name:STATE OF NEVADA
Entity Type:Organization
Organization Name:STATE OF NEVADA
Other - Org Name:AGING AND DISABILITY SERVICES DIVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-687-0534
Mailing Address - Street 1:3416 GONI RD BLDG D
Mailing Address - Street 2:132
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-8008
Mailing Address - Country:US
Mailing Address - Phone:775-687-4210
Mailing Address - Fax:775-687-0574
Practice Address - Street 1:3416 GONI RD BLDG D
Practice Address - Street 2:132
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-8008
Practice Address - Country:US
Practice Address - Phone:775-687-4210
Practice Address - Fax:775-687-0574
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management