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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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