Provider Demographics
NPI:1629540380
Name:VITALITY INTEGRATED PROGRAMS - CCBHC - CARSON CITY
Entity Type:Organization
Organization Name:VITALITY INTEGRATED PROGRAMS - CCBHC - CARSON CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CPA, CGMA
Authorized Official - Phone:775-738-4158
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803-2580
Mailing Address - Country:US
Mailing Address - Phone:775-738-4158
Mailing Address - Fax:775-753-6487
Practice Address - Street 1:680 W NYE LN STE AND202
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-1575
Practice Address - Country:US
Practice Address - Phone:775-738-4158
Practice Address - Fax:775-753-6487
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITALITY UNLIMITED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health