Provider Demographics
NPI:1821607193
Name:STATE OF NEVADA
Entity Type:Organization
Organization Name:STATE OF NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-684-7942
Mailing Address - Street 1:2655 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1666
Mailing Address - Country:US
Mailing Address - Phone:775-688-1600
Mailing Address - Fax:775-688-1616
Practice Address - Street 1:6171 W CHARLESTON BLVD BLDG 15
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:775-688-1481
Practice Address - Fax:775-688-1230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health