Provider Demographics
NPI:1821630328
Name:SILVER STATE HEALTH SERVICES
Entity Type:Organization
Organization Name:SILVER STATE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-471-0420
Mailing Address - Street 1:2965 S JONES BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5606
Mailing Address - Country:US
Mailing Address - Phone:702-410-9195
Mailing Address - Fax:
Practice Address - Street 1:2965 S JONES BLVD STE C1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5629
Practice Address - Country:US
Practice Address - Phone:702-410-9195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SILVER STATE HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-16
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)