# UNEPECTED CHANGES

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093030017
- **Authorized official:** JACQUELINE C EDWARDS (CEO/OWNER)
- **Authorized official phone:** (702) 353-2467

## Contact information

- **Practice address:** 428 MARION DR, LAS VEGAS, NV 89110-3473
- **Practice address phone:** (702) 353-2467
- **Mailing address:** 4701 LAWRENCE ST UNIT 1138, NORTH LAS VEGAS, NV 89081-4200
- **Mailing address phone:** (702) 353-2467

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 04/01/2010
- **Last updated:** 04/01/2010