Provider Demographics
NPI:1417317025
Name:NORTHERN NEVADA HUMAN SERVICES
Entity Type:Organization
Organization Name:NORTHERN NEVADA HUMAN SERVICES
Other - Org Name:SONOMA INDUSTRIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:LIZER
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:775-625-3939
Mailing Address - Street 1:3280 BENGOCHEA CIR
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-2627
Mailing Address - Country:US
Mailing Address - Phone:775-625-3939
Mailing Address - Fax:775-625-3944
Practice Address - Street 1:307 E 4TH ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-2823
Practice Address - Country:US
Practice Address - Phone:775-625-3939
Practice Address - Fax:775-625-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care