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2675 S Jones Blvd Ste 102 Las Vegas NV 89146-5607 | |
| (702) 951-9751 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2675 S Jones Blvd Ste 102, Las Vegas, Nevada |
| Authorized Official Name and Position | Kay Anderson (HUMAN RESOURCES) |
| Authorized Official Contact | 7029519751 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2675 S Jones Blvd Ste 102 Las Vegas NV 89146-5607 Ph: (702) 951-9751 | 2675 S Jones Blvd Ste 102 Las Vegas NV 89146-5607 Ph: (702) 951-9751 |
| NPI Number | 1447512546 |
|---|---|
| Provider Enumeration Date | 06/13/2012 |
| Last Update Date | 06/07/2022 |
| Certification Date | 06/07/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447512546 | NPI | - | NPPES |
| 1053417345 | Medicaid | NV | |
| 1164739017 | Medicaid | NV | |
| 1679797633 | Medicaid | NV | |
| 1366741183 | Medicaid | NV | |
| 1740597715 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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