Provider Demographics
NPI:1619338878
Name:NV ST DV MH/DS NO NV MR SVCE
Entity Type:Organization
Organization Name:NV ST DV MH/DS NO NV MR SVCE
Other - Org Name:OFFICE OF THE STATE CONTROLLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING ASSISTANT IV
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-688-1930
Mailing Address - Street 1:605 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-8100
Mailing Address - Country:US
Mailing Address - Phone:775-688-1930
Mailing Address - Fax:
Practice Address - Street 1:605 S 21ST ST
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8100
Practice Address - Country:US
Practice Address - Phone:775-688-1930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0360385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005040611Medicaid