| NPI | 1801308655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIE DANIEL TAQUIQUI Owner 702-806-5198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NV NV20171436936) |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2017-11-02 |