| Vitality Unlimited | |
|
3740 E Idaho St Elko NV 89801-4611 | |
| (775) 738-4158 | |
| (775) 753-6487 |
| Full Name | Vitality Unlimited |
|---|---|
| Speciality | Clinic/Center |
| Location | 3740 E Idaho St, Elko, Nevada |
| Authorized Official Name and Position | Dorothy Jean Dexter (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7757384158 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Unlimited Po Box 2580 Elko NV 89803-2580 Ph: (775) 738-4158 | Vitality Unlimited 3740 E Idaho St Elko NV 89801-4611 Ph: (775) 738-4158 |
| NPI Number | 1912445073 |
|---|---|
| Provider Enumeration Date | 02/08/2017 |
| Last Update Date | 09/24/2020 |
| Certification Date | 09/24/2020 |
| Medicare PECOS PAC ID | 4688095078 |
|---|---|
| Medicare Enrollment ID | O20201014003105 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912445073 | NPI | - | NPPES |
| 1376624494 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (Nevada) | Primary |
| Provider Name | Carla R Farnworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093804213 PECOS PAC ID: 9931268794 Enrollment ID: I20081107000517 |
| Provider Name | Manpreet Sandhu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801260534 PECOS PAC ID: 0446557748 Enrollment ID: I20160331002619 |
| Provider Name | Gordon Frank Cvach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336423995 PECOS PAC ID: 7012279391 Enrollment ID: I20180326002676 |
| Provider Name | Joshua A. Pierce |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366085870 PECOS PAC ID: 9032545041 Enrollment ID: I20200212000010 |
| Provider Name | David A Birnbaum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285631580 PECOS PAC ID: 6103804471 Enrollment ID: I20200302002215 |
| Provider Name | Valan A Kam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730728585 PECOS PAC ID: 4385071299 Enrollment ID: I20200305000008 |
| Provider Name | Roberta Mcmordie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427303700 PECOS PAC ID: 8921429853 Enrollment ID: I20200602001362 |
| Provider Name | Bethany L Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942775895 PECOS PAC ID: 1951640549 Enrollment ID: I20200605000873 |
| Provider Name | Heather Eaton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457801987 PECOS PAC ID: 4587074885 Enrollment ID: I20201027002198 |
| Provider Name | Winta Haile |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972954907 PECOS PAC ID: 3577973882 Enrollment ID: I20201027002639 |
| Provider Name | Thalia Paulina Maya |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568908275 PECOS PAC ID: 1759795032 Enrollment ID: I20210127003069 |
| Provider Name | Elizabeth Hawthorne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851764609 PECOS PAC ID: 7315353562 Enrollment ID: I20210312000848 |
| Provider Name | Stephanie Vargas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811494081 PECOS PAC ID: 2466859947 Enrollment ID: I20210927000819 |
| Provider Name | Stephan Mclaughlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962964395 PECOS PAC ID: 7012306913 Enrollment ID: I20211115002884 |
| Provider Name | Tera Riddick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437683174 PECOS PAC ID: 2860896610 Enrollment ID: I20220117000640 |
| Provider Name | Bailey Jo Griffin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487226155 PECOS PAC ID: 2961894704 Enrollment ID: I20220127002880 |
| Provider Name | Pamelia Sublett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104192707 PECOS PAC ID: 1951540152 Enrollment ID: I20221230002178 |
| Provider Name | Amelia Landry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639844012 PECOS PAC ID: 9931574571 Enrollment ID: I20230412001615 |
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