| NPI | 1609136035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK JAMES BROXTERMAN Owner 702-429-2654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NV nv20121198867) |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2012-07-13 |