| NPI | 1861701062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY LYNN MOSLEY Office Manager/Compliance Officer 702-880-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NV 2000394-810) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NV 2061-0219) |
| 305S00000X Point of Service (Licence: NV 2061-0219) | |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2011-01-14 |