Provider Demographics
NPI:1407030299
Name:NEVADA HEALTH CENTERS, INC.
Entity Type:Organization
Organization Name:NEVADA HEALTH CENTERS, INC.
Other - Org Name:JACKPOT COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:INGREY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:775-888-6610
Mailing Address - Street 1:1802 N CARSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-1227
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:775-887-7046
Practice Address - Street 1:135 KENO STREET
Practice Address - Street 2:
Practice Address - City:JACKPOT
Practice Address - State:NV
Practice Address - Zip Code:89825
Practice Address - Country:US
Practice Address - Phone:775-755-2500
Practice Address - Fax:775-755-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH12123336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy