| NPI | 1346671344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIQUE BLAKE BASS Director 702-300-0816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NV NV20131697710) |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2013-12-02 |