| NPI | 1104373646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORNELIUS DZAMESI Owner 702-893-2002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NV 2000558062101) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2018-06-20 |