| Diversified Community Services Community Development Corporation | |
|
2820 E Lake Mead Blvd North Las Vegas NV 89030-6514 | |
| (702) 749-8500 | |
| (702) 749-8509 |
| Full Name | Diversified Community Services Community Development Corporation |
|---|---|
| Speciality | Behavior Analyst |
| Location | 2820 E Lake Mead Blvd, North Las Vegas, Nevada |
| Authorized Official Name and Position | Shannon Ashford (OFFICE ADDIMINSTRATOR) |
| Authorized Official Contact | 7027498500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diversified Community Services Community Development Corporation 2820 E Lake Mead Blvd North Las Vegas NV 89030-6514 Ph: (702) 749-8500 | Diversified Community Services Community Development Corporation 2820 E Lake Mead Blvd North Las Vegas NV 89030-6514 Ph: (702) 749-8500 |
| NPI Number | 1295011906 |
|---|---|
| Provider Enumeration Date | 10/26/2011 |
| Last Update Date | 04/24/2017 |
| Medicare PECOS PAC ID | 3971886201 |
|---|---|
| Medicare Enrollment ID | O20170213001124 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295011906 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (Nevada) | Primary |
| Provider Name | Ericka L Severs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629309208 PECOS PAC ID: 2365729498 Enrollment ID: I20170427001493 |
| Provider Name | Anthony F Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407046535 PECOS PAC ID: 0749557544 Enrollment ID: I20170809001959 |
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