| |
101 S Rainbow Blvd Ste 1 Las Vegas NV 89145-5370 | |
(702) 778-8922 | |
(702) 778-8789 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 101 S Rainbow Blvd Ste 1, Las Vegas, Nevada |
Authorized Official Name and Position | Nakeia Funches (OFFICE MANAGER) |
Authorized Official Contact | 7027766202 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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101 S Rainbow Blvd Ste 1 Las Vegas NV 89145-5370 Ph: (702) 778-8922 | 101 S Rainbow Blvd Ste 1 Las Vegas NV 89145-5370 Ph: (702) 778-8922 |
NPI Number | 1639470172 |
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Provider Enumeration Date | 11/16/2010 |
Last Update Date | 04/07/2015 |
Identifier | Type | State | Issuer |
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1639470172 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | E0653822009-0 (Nevada) | Primary |
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