| NPI | 1295354132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | UNKNOWN DAHJ Owner 702-381-2066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2020-10-07 |