| NPI | 1790212900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE CHADDICK Owner 702-931-8990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: NV CI0276) |
| Additional Taxonomies | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: NV NV20171307801) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2017-05-18 |