Provider Demographics
NPI:1679640023
Name:STATE OF NEVADA
Entity Type:Organization
Organization Name:STATE OF NEVADA
Other - Org Name:SOUTHERN NEVADA CHILD AND ADOLESCENT SERVICES, SNCAS PSYCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGEMENT ANALYST 3
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-486-8226
Mailing Address - Street 1:1350 S JONES BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1233
Mailing Address - Country:US
Mailing Address - Phone:702-486-8226
Mailing Address - Fax:702-486-6057
Practice Address - Street 1:6171 W CHARLESTON BLVD BLDG 10
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1126
Practice Address - Country:US
Practice Address - Phone:702-486-7865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV005402800Medicaid