Organization
MAPLE STAR NEVADA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTOINETTE POULSON (PROGRAM MANAGER)
(775) 677-2216
Entity
Organization
Contact information
Practice address
855 W 7TH ST STE 160, RENO, NV 89503-2706
(775) 677-2216
(775) 322-4460
Mailing address
855 W 7TH ST STE 160, RENO, NV 89503-2706
(775) 677-2216
(775) 322-4460
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100508114
—
NV
Enumeration date
02/12/2007
Last updated
11/02/2020
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