Organization
STATE OF NEVADA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANELLE MULVENON (BUREAU CHIEF)
(775) 684-3461
Entity
Organization
Contact information
Practice address
1161 S VALLEY VIEW BLVD, LAS VEGAS, NV 89102-1854
(702) 486-7670
Mailing address
1161 S VALLEY VIEW BLVD, LAS VEGAS, NV 89102-1854
(702) 486-7670
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001702024
—
NV
05
—
005402024
—
NV
Enumeration date
10/05/2006
Last updated
06/20/2008
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