| NPI | 1114843992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERMAINE SMITH Provider 702-764-8493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2026-06-26 |
| Last Update Date | 2026-07-03 |