| NPI | 1336731686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMI V BASS Administrator 702-591-3055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QC1500X Clinic/Center Community Health |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2021-02-08 |