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6900 Westcliff Dr Ste 504 Las Vegas NV 89145-0198 | |
| (702) 778-9875 | |
| (702) 778-9863 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 6900 Westcliff Dr Ste 504, Las Vegas, Nevada |
| Authorized Official Name and Position | Leonard Eugene Deforge (ADMIN) |
| Authorized Official Contact | 0277789875 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6900 Westcliff Dr Ste 504 Las Vegas NV 89145-0198 Ph: (702) 787-7059 | 6900 Westcliff Dr Ste 504 Las Vegas NV 89145-0198 Ph: (702) 778-9875 |
| NPI Number | 1104326438 |
|---|---|
| Provider Enumeration Date | 02/13/2018 |
| Last Update Date | 12/26/2024 |
| Certification Date | 12/26/2024 |
| Medicare PECOS PAC ID | 4880959337 |
|---|---|
| Medicare Enrollment ID | O20180604001246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104326438 | NPI | - | NPPES |
| 100532491 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (Nevada) | Primary |
| Provider Name | Warren J Wheatley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033327580 PECOS PAC ID: 1557585791 Enrollment ID: I20140610001089 |
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