Provider Demographics
NPI:1558550392
Name:SPECIALIZED ALTERNATIVE FOR FAMILIES AND YOUTH OF NEVADA
Entity Type:Organization
Organization Name:SPECIALIZED ALTERNATIVE FOR FAMILIES AND YOUTH OF NEVADA
Other - Org Name:SAFY OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STATE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KURCZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/LSW
Authorized Official - Phone:702-385-5331
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9056
Mailing Address - Country:US
Mailing Address - Phone:419-695-8010
Mailing Address - Fax:419-695-0004
Practice Address - Street 1:4495 W HACIENDA AVE STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1541
Practice Address - Country:US
Practice Address - Phone:702-385-5331
Practice Address - Fax:703-385-5678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health