OrganizationState Of NevadaCommunity/Behavioral HealthAgenciesPractice Address6171 W Charleston Blvd Bldg 15, Las Vegas, NV 89146(775) 688-1481(775) 688-1600PECOS EnrollmentBased on the most recent information from CMS, provider State Of Nevada does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1821607193Provider TypeOrganizationFull NameState Of NevadaSubpartYesEnumeration Date7/23/2020Last Updated7/23/2020Contact InformationPractice LocationPractice Address6171 W Charleston Blvd Bldg 15, Las Vegas, NV 89146Phone(775) 688-1481Fax(775) 688-1230Mailing LocationMailing Address2655 Enterprise Dr, Reno, NV 89512-1666Phone(775) 688-1600Fax(775) 688-1616Authorized OfficialNameDavis, Mandi (Deputy Administrator)Phone(775) 684-7942Provider TaxonomiesCodeDescriptionLicenseCode251S00000XPrimaryDescriptionCommunity/Behavioral HealthAgenciesLicenseUnlisted Issuer