Provider Demographics
NPI:1902075005
Name:MGA ENTERPRISES, INC.
Entity Type:Organization
Organization Name:MGA ENTERPRISES, INC.
Other - Org Name:PATHWAYS OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-219-8788
Mailing Address - Street 1:2980 S RAINBOW BLVD
Mailing Address - Street 2:#220 E.
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6531
Mailing Address - Country:US
Mailing Address - Phone:702-219-8788
Mailing Address - Fax:702-889-4406
Practice Address - Street 1:2980 S RAINBOW BLVD
Practice Address - Street 2:#220 E.
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6531
Practice Address - Country:US
Practice Address - Phone:702-219-8788
Practice Address - Fax:702-889-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2001155-237251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507843Medicaid
NV100507845Medicaid
NV100507846Medicaid
NV100507847Medicaid
NV100507848Medicaid
NV100508809Medicaid