Organization
STATE OF NEVADA
Active
Organization
STATE OF NEVADA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MERRYLYN MERCER (ACCOUNTANT TECH I)
(775) 687-2484
Entity
Organization
Contact information
Practice address
2667 ENTERPRISE RD, RENO, NV 89512-1666
(775) 688-1341
(775) 688-2984
Mailing address
2667 ENTERPRISE RD, RENO, NV 89512-1666
(775) 688-1341
(775) 688-2984
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
—
001716024
—
NV
05
—
005416024
—
NV
Enumeration date
09/20/2006
Last updated
12/31/2019
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