| NPI | 1932575156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FESTUS EBONKA EBONKA Program Director 702-515-9680 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone (Licence: NV 8352NTC-0) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2015-08-12 |