Provider Demographics
NPI:1801485131
Name:SOUTHERN NEVADA CARE CENTER
Entity type:Organization
Organization Name:SOUTHERN NEVADA CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARICHU
Authorized Official - Middle Name:
Authorized Official - Last Name:PIZAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-239-9235
Mailing Address - Street 1:8854 CARRADORI AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4940
Mailing Address - Country:US
Mailing Address - Phone:702-239-9235
Mailing Address - Fax:702-947-2287
Practice Address - Street 1:1330 KAREN AVE UNIT B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-1260
Practice Address - Country:US
Practice Address - Phone:702-239-9235
Practice Address - Fax:702-947-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1801485131Medicaid