Provider Demographics
NPI:1912367889
Name:STATE OF NEVADA DESERT REGIONAL CENTER
Entity Type:Organization
Organization Name:STATE OF NEVADA DESERT REGIONAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SERVICES OFFICER III
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHCRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-687-0511
Mailing Address - Street 1:1391 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1200
Mailing Address - Country:US
Mailing Address - Phone:702-486-6200
Mailing Address - Fax:
Practice Address - Street 1:1391 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1200
Practice Address - Country:US
Practice Address - Phone:702-486-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child