Provider Demographics
NPI:1851989859
Name:ADAMS, STEVIE RON JR (IHSS PROVIDER)
Entity Type:Individual
Prefix:
First Name:STEVIE
Middle Name:RON
Last Name:ADAMS
Suffix:JR
Gender:M
Credentials:IHSS PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6867 MOMENTOS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3006
Mailing Address - Country:US
Mailing Address - Phone:562-502-0050
Mailing Address - Fax:
Practice Address - Street 1:2317 WENGERT AVE APT 36
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-2155
Practice Address - Country:US
Practice Address - Phone:562-502-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV00001863865Medicaid