Provider Demographics
NPI:1316574064
Name:STATE OF NEVADA
Entity Type:Organization
Organization Name:STATE OF NEVADA
Other - Org Name:PRTF ENTERPRISE
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGEMENT ANALYST 3
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-486-8226
Mailing Address - Street 1:1350 S JONES BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1233
Mailing Address - Country:US
Mailing Address - Phone:702-486-8226
Mailing Address - Fax:702-486-6057
Practice Address - Street 1:2655 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1666
Practice Address - Country:US
Practice Address - Phone:775-688-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-24
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250010316Medicaid