NEVADA FAMILY PRACTICE RESIDENCY PROGRAM, INC. (NPI# 1407051717) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407051717 |
| Entity Type | Organization |
| Organization Name | NEVADA FAMILY PRACTICE RESIDENCY PROGRAM, INC. |
| Other Organization Name | MOJAVE MENTAL HEALTH |
| Practice Address |
4000 E Charleston Blvd Suite 230 Las Vegas NV 89104-6659 |
| Practice Telephone | 7029685059 |
| Practice Fax Number | 7029684041 |
| Mailing Telephone | 7029685059 |
| Mailing Fax Number | 7029684041 |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2008-06-17 |
| Authorized Official Name | JAMES R PARCELLS (PRESIDENT) |
| Authorized Official Telephone | 7029685059 |
| Authorized Official Credential | LISW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
NV | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | 005402100 | 05 |
| Other Name | Type Code |
|---|---|
| Mojave Mental Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316142623 | Nevada Family Practice Residency Program, Inc. | Clinic/Center | 745 W Moana Ln, Suite 100, Reno, NV 89509-4932 | 2007-06-18 |
| 1497780167 | Nevada Family Practice Residency Program, Inc. | Clinic/Center | 745 W Moana Ln, Suite 100, Reno, NV 89509-4932 | 2006-07-11 |
| 1366477036 | Nevada Family Practice Residency Program, Inc. | Clinic/Center | 4000 E Charleston Blvd, Suite 230, Las Vegas, NV 89104-6659 | 2006-07-11 |
| Street Address |
4000 E CHARLESTON BLVD SUITE 230 |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89104-6659 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083683874 | Nevada Family Practice Residence Program | Pharmacy | 4000 E Charleston Blvd, B-130, Las Vegas, NV 89104-6659 | 2006-03-15 |
| 1598207847 | Delores Glenn-lewis | Counselor | 4000 E Charleston Blvd, 226, Las Vegas, NV 89104-6659 | 2016-11-17 |
| 1447602974 | Dori Hilson | Social Worker | 4000 E Charleston Blvd, Las Vegas, NV 89104-6659 | 2016-07-08 |
| 1386096766 | Alexis Harris | Community Health Worker | 4000 E Charleston Blvd, Ste. 230, Las Vegas, NV 89104-6659 | 2016-07-08 |
| 1770930133 | Erin Maria Spanberger | Counselor | 4000 E Charleston Blvd, Suite #230, Las Vegas, NV 89104-6659 | 2016-05-16 |
| 1447619267 | Brandi Mcconnell | Social Worker | 4000 E Charleston Blvd, Suite 230, Las Vegas, NV 89104-6659 | 2016-02-22 |
| 1548639271 | Desirae Chantal Murenzi | Registered Nurse | 4000 E Charleston Blvd, Sutie 230, Las Vegas, NV 89104-6659 | 2015-09-23 |
| 1518335801 | Angela Acuna | Registered Nurse | 4000 E Charleston Blvd, Suite 230, Las Vegas, NV 89104-6659 | 2015-09-03 |
| 1053795898 | Natalie Rose Schmaltz | Social Worker | 4000 E Charleston Blvd, 230, Las Vegas, NV 89104-6659 | 2015-07-10 |
| 1124456033 | Winnie Wegner | Registered Nurse | 4000 E Charleston Blvd, Ste #130, Las Vegas, NV 89104-6659 | 2013-10-31 |
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|---|---|---|---|---|
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| 1003448333 | Shirley Lauren Valenzona-gianan | Pharmacist | Smith's Pharmacy #318, 4965 East Sahara Avenue, Las Vegas, NV 89104 | 2020-02-05 |
| 1427602713 | Alma Lucia Lozano-vargas | Chore Provider | 1785 E. Sahara Ave. Suite 485, Las Vegas, NV 89104 | 2019-07-25 |
| 1396398947 | Martinez Antuan Coates | Psychologist | 1755 Palm St Bld T Apt147, Las Vegas, NV 89104 | 2019-07-23 |
| 1982171518 | Ian Sande | Occupational Therapist | 1500 West Warm Springs Rd, Las Vegas, NV 89104 | 2018-11-01 |
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| 1760901581 | Fannie Bell | Counselor | 1800 E. Sahara Suite 104, Las Vegas, NV 89104 | 2017-09-13 |
| 1386162147 | Jaclyn Mustachio | Social Worker | 1860 E Sahara Ave, Las Vegas, NV 89104 | 2017-08-31 |
| Find all providers in zip 89104 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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| 1225656358 | Behavioral and Health Management LLC | Clinic/Center | 1500 E Tropicana Ave Ste 155, Las Vegas, NV 89119-6516 | 2020-07-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.