Organization
MY HOME ICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ELIZABETH ROBIN WEBB (PROGRAM DIRECTOR)
(702) 595-2868
Entity
Organization
Contact information
Practice address
10880 DEODAR WAY, RENO, NV 89506-9064
(775) 786-4168
(775) 786-5622
Mailing address
10880 DEODAR WAY, RENO, NV 89506-9064
(775) 786-4168
(775) 786-5622
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9005042666
—
NV
Enumeration date
05/24/2011
Last updated
05/24/2011
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