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3652 N Rancho Dr Suite 102 Las Vegas NV 89130-3178 | |
| (510) 385-4456 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3652 N Rancho Dr, Las Vegas, Nevada |
| Authorized Official Name and Position | Percy A Irving (MANAGING MEMBER) |
| Authorized Official Contact | 5103854456 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1034 10th St Oakland CA 94607-2720 Ph: () - | 3652 N Rancho Dr Suite 102 Las Vegas NV 89130-3178 Ph: (510) 385-4456 |
| NPI Number | 1699049056 |
|---|---|
| Provider Enumeration Date | 03/02/2012 |
| Last Update Date | 02/12/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699049056 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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