Provider Demographics
NPI:1235895871
Name:NORTHERN NEVADA HIV OUTPATIENT PROGRAM, EDUCATION AND SERVICES
Entity Type:Organization
Organization Name:NORTHERN NEVADA HIV OUTPATIENT PROGRAM, EDUCATION AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DE VAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-997-7579
Mailing Address - Street 1:580 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4407
Mailing Address - Country:US
Mailing Address - Phone:775-786-4673
Mailing Address - Fax:775-348-2889
Practice Address - Street 1:595 BELL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4430
Practice Address - Country:US
Practice Address - Phone:775-786-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN NEVADA HIV OUTPATIENT PROGRAM, EDUCATION AND SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-09
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)