| NPI | 1437683232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZEPHRA JACKSON Owner 702-206-2328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NV NV20171249461) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2017-04-18 |