# IGNITE TEEN TREATMENT, LLC

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

## Provider details

- **NPI number:** 1316551682
- **Authorized official:** MELISSA MARSHALL (DIRECTOR OF BILLING & COLLECTIONS)
- **Authorized official phone:** (570) 203-9222

## Contact information

- **Practice address:** 2761 FAMILY CT, LAS VEGAS, NV 89117-2601
- **Practice address phone:** (866) 604-7273
- **Mailing address:** 512 NORTHAMPTON ST \# 158, EDWARDSVILLE, PA 18704-4560
- **Mailing address phone:** (570) 203-9222
- **Mailing address fax:** (570) 203-9477

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |
| 324500000X | Substance Abuse Rehabilitation Facility | — | NULL | — |

## Other

- **Enumeration date:** 09/03/2020
- **Last updated:** 11/20/2023