Provider Demographics
NPI:1053557900
Name:SOUTHERN NEVADA ADULT MENTAL HEALTH
Entity type:Organization
Organization Name:SOUTHERN NEVADA ADULT MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATEWIDE PHARMACY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:EBO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:702-486-6570
Mailing Address - Street 1:6161 WEST CHARLESTON
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1126
Mailing Address - Country:US
Mailing Address - Phone:702-486-6570
Mailing Address - Fax:702-486-8330
Practice Address - Street 1:1650 COMMUNITY COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-486-6570
Practice Address - Fax:702-486-8330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-24
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1B00759283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital