Provider Demographics
NPI:1740575794
Name:MAPLE STAR NEVADA
Entity Type:Organization
Organization Name:MAPLE STAR NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, LSW
Authorized Official - Phone:702-733-8098
Mailing Address - Street 1:1050 E FLAMINGO RD
Mailing Address - Street 2:STE S-107
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7427
Mailing Address - Country:US
Mailing Address - Phone:702-733-8098
Mailing Address - Fax:702-395-6457
Practice Address - Street 1:1050 E FLAMINGO RD
Practice Address - Street 2:STE S-107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7427
Practice Address - Country:US
Practice Address - Phone:702-733-8098
Practice Address - Fax:702-395-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)