| Ubu Sports Mentoring | |
|
5135 Camino Al Norte Ave., Suite 100 North Las Vegas NV 89031-8104 | |
| (941) 587-4953 | |
| (702) 853-7001 |
| Full Name | Ubu Sports Mentoring |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5135 Camino Al Norte Ave., Suite 100, North Las Vegas, Nevada |
| Authorized Official Name and Position | Corey A. Moore (OWNER/DIRECT SUPERVISON) |
| Authorized Official Contact | 9415874953 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ubu Sports Mentoring 5135 Camino Al Norte Ave., Suite 100 North Las Vegas NV 89031-8104 Ph: (941) 587-4953 | Ubu Sports Mentoring 5135 Camino Al Norte Ave., Suite 100 North Las Vegas NV 89031-8104 Ph: (941) 587-4953 |
| NPI Number | 1841679891 |
|---|---|
| Provider Enumeration Date | 05/22/2015 |
| Last Update Date | 04/20/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841679891 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | NV20151051263 (Nevada) | Primary |
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