| NPI | 1003177171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLEVONNE FUNCHES Administrator 702-754-3484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NV NV20131188171) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2016-03-10 |