Provider Demographics
NPI:1578764361
Name:CHURCHILL COUNCIL ON ALCOHOL & OTHER DRUGS
Entity Type:Organization
Organization Name:CHURCHILL COUNCIL ON ALCOHOL & OTHER DRUGS
Other - Org Name:NEW FRONTIER TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROBARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-423-1412
Mailing Address - Street 1:PO BOX 1240
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89407-1240
Mailing Address - Country:US
Mailing Address - Phone:775-423-1412
Mailing Address - Fax:775-423-4054
Practice Address - Street 1:1490 GRIMES ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3103
Practice Address - Country:US
Practice Address - Phone:775-423-1412
Practice Address - Fax:775-423-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5ADA-12324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510924Medicaid
NV100510923Medicaid