Provider Demographics
NPI:1891756920
Name:SOUTHERN NEVADA ADULT MENTAL HEALTH
Entity Type:Organization
Organization Name:SOUTHERN NEVADA ADULT MENTAL HEALTH
Other - Org Name:SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:RATES & COST CONTAINMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:MOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-684-5990
Mailing Address - Street 1:4150 TECHNOLOGY WAY
Mailing Address - Street 2:STE:300
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-2026
Mailing Address - Country:US
Mailing Address - Phone:775-684-4051
Mailing Address - Fax:
Practice Address - Street 1:6161 W CHARLESTON BLVD
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:702-486-6000
Practice Address - Fax:702-486-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 283Q00000X
NVPH021103336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No283Q00000XHospitalsPsychiatric Hospital
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2052189OtherPK
NV294002Medicare Oscar/Certification
NV9005045651Medicaid
NV100508944Medicaid
NV294002Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NV002019897Medicaid
NV005402897Medicaid
NV002802006Medicaid