# SUPER YOUTH OF NEVADA

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

## Provider details

- **NPI number:** 1174895890
- **Authorized official:** MR. DEMETRIUS JEMIL HUNTER (MANAGER)
- **Authorized official phone:** (702) 748-1508

## Contact information

- **Practice address:** 867 WORRELL AVE, LAS VEGAS, NV 89123-3183
- **Practice address phone:** (702) 748-1508
- **Mailing address:** 867 WORRELL AVE., LAS VEGAS, NV 89123-3183
- **Mailing address phone:** (702) 748-1508

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225400000X | Rehabilitation Practitioner | — | NV | Yes |

## Other

- **Enumeration date:** 01/27/2012
- **Last updated:** 04/11/2012