Provider Demographics
NPI:1396200838
Name:SILVER STATE HEALTH SERVICES
Entity Type:Organization
Organization Name:SILVER STATE HEALTH SERVICES
Other - Org Name:SILVER STATE BH AT RENAISSANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-808-5739
Mailing Address - Street 1:2255A RENAISSANCE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6194
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1909 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1260
Practice Address - Country:US
Practice Address - Phone:702-471-0420
Practice Address - Fax:702-471-0421
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SILVER STATE HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-08
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)