Basic Information
| Provider Information | |||||||||
| NPI: | 1851574305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTCARE NEVADA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 94378 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891934378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023852090 | ||||||||
| FaxNumber: | 7029242575 | ||||||||
| Practice Location | |||||||||
| Address1: | 323 N MARYLAND PKWY | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891013130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028533330 | ||||||||
| FaxNumber: | 7029242575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2007 | ||||||||
| LastUpdateDate: | 12/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | ORTBALS | ||||||||
| AuthorizedOfficialFirstName: | KEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7023852090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | N35000041112243 | NV | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 251B00000X | N | Agencies | Case Management | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 100508912 | 05 | NV | MEDICAID | 100511279 | 05 | NV | MEDICAID |