| Maple Star Nevada Llc | |
|
855 W 7th St Ste 160 Reno NV 89503-2706 | |
| (775) 677-2216 | |
| (775) 322-4460 |
| Full Name | Maple Star Nevada Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 855 W 7th St Ste 160, Reno, Nevada |
| Authorized Official Name and Position | Antoinette Poulson (PROGRAM MANAGER) |
| Authorized Official Contact | 7756772216 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maple Star Nevada Llc 855 W 7th St Ste 160 Reno NV 89503-2706 Ph: (775) 677-2216 | Maple Star Nevada Llc 855 W 7th St Ste 160 Reno NV 89503-2706 Ph: (775) 677-2216 |
| NPI Number | 1457492332 |
|---|---|
| Provider Enumeration Date | 02/12/2007 |
| Last Update Date | 11/02/2020 |
| Certification Date | 11/02/2020 |
| Medicare PECOS PAC ID | 1254570872 |
|---|---|
| Medicare Enrollment ID | O20171030003224 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457492332 | NPI | - | NPPES |
| 100508114 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Alvin Kenon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275913030 PECOS PAC ID: 5395173017 Enrollment ID: I20200311002457 |
| Provider Name | Tanya Sue Pellant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730486515 PECOS PAC ID: 8224450416 Enrollment ID: I20200616002773 |
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