Provider Demographics
NPI:1497780167
Name:NEVADA FAMILY PRACTICE RESIDENCY PROGRAM, INC.
Entity Type:Organization
Organization Name:NEVADA FAMILY PRACTICE RESIDENCY PROGRAM, INC.
Other - Org Name:MOJAVE ADULT, CHILD AND FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARCELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:702-968-5059
Mailing Address - Street 1:745 W MOANA LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4932
Mailing Address - Country:US
Mailing Address - Phone:775-334-3033
Mailing Address - Fax:775-334-3022
Practice Address - Street 1:745 W MOANA LN
Practice Address - Street 2:SUITE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4932
Practice Address - Country:US
Practice Address - Phone:775-334-3033
Practice Address - Fax:775-334-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507636Medicaid
NV100508691Medicaid
NV100508050Medicaid
NV100508692Medicaid
NV100507635Medicaid
NV100507630Medicaid
NV100507632Medicaid
NV100507633Medicaid
NV100507631Medicaid
NV100507630Medicaid