| Tower Bridge Developmental Health Center | |
|
9484 S Eastern Ave Suite 67 Las Vegas NV 89123-3987 | |
| (702) 513-8321 | |
| Not Available |
| Full Name | Tower Bridge Developmental Health Center |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 9484 S Eastern Ave, Las Vegas, Nevada |
| Authorized Official Name and Position | Shana Wickersham (OWNER) |
| Authorized Official Contact | 7025138321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tower Bridge Developmental Health Center 9484 S Eastern Ave Suite 67 Las Vegas NV 89123-3987 Ph: (702) 513-8321 | Tower Bridge Developmental Health Center 9484 S Eastern Ave Suite 67 Las Vegas NV 89123-3987 Ph: (702) 513-8321 |
| NPI Number | 1912268467 |
|---|---|
| Provider Enumeration Date | 05/31/2012 |
| Last Update Date | 05/31/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912268467 | NPI | - | NPPES |
| 1679847040 | Medicaid | NV | |
| 1750642310 | Medicaid | NV | |
| 1053417345 | Medicaid | NV | |
| 1487953915 | Medicaid | NV | |
| 1619968021 | Medicaid | NV | |
| 1912272527 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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