| NPI | 1073026662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICE DELIA PETERSON Owner 702-628-1223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2017-11-20 |