Organization
GOLLA HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEAN GOLLA (MH TREATMENT HOME PROVIDER)
(775) 849-3165
Entity
Organization
Contact information
Practice address
670 WASHOE DR, CARSON CITY, NV 89704-9528
(775) 849-3165
(775) 849-9425
Mailing address
670 WASHOE DR, CARSON CITY, NV 89704-9528
(775) 849-3165
(775) 849-9425
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006116513
—
NV
05
—
100508066
—
NV
05
—
100508067
—
NV
Enumeration date
11/08/2006
Last updated
06/23/2008
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