| NPI | 1104221795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITRIECE AMELIA SUMBRY Owner 702-419-1262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NV C201410130539) |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2014-10-27 |