NPIMap

Organization Active NPI

Golla Home

  • Community/Behavioral Health Agency
  • Carson City, NV
National Provider Identifier
1992875157
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
GOLLA HOME
Practice address
670 Washoe Dr
Carson City, NV 89704-9528
Phone
(775) 849-3165
Fax
(775) 849-9425
NPI assigned
Nov 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jean GollaNPI 1730489998
Title
MH Treatment Home Provider
Phone
(775) 849-3165

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

670 Washoe Dr
Carson City, NV 89704-9528

Mailing address

670 Washoe Dr
Carson City, NV 89704-9528
Phone (775) 849-3165

Other identifiers 3

IdentifierTypeStateIssuer
100508067MedicaidNV
006116513MedicaidNV
100508066MedicaidNV

National Provider Directory

National Provider Directory
Tax ID family
Golla Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1992875157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 WASHOE DR",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897049528",
            "telephone_number": "775-849-3165",
            "fax_number": "775-849-9425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 WASHOE DR",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897049528",
            "telephone_number": "775-849-3165",
            "fax_number": "775-849-9425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLLA HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "GOLLA",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "MH TREATMENT HOME PROVIDER",
        "authorized_official_telephone_number": "775-849-3165",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100508067",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006116513",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100508066",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carson City, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.