# APPLE GROVE TREATMENT CENTER

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

## Provider details

- **NPI number:** 1346429495
- **Authorized official:** ICIA REID SANDULAK BSW (DIRECTOR)
- **Authorized official phone:** (702) 369-0396

## Contact information

- **Practice address:** 2060 WAVERLY CIR, HENDERSON, NV 89014-4593
- **Practice address phone:** (702) 369-0396
- **Mailing address:** 368 PLACER CREEK LN, HENDERSON, NV 89014-4557
- **Mailing address phone:** (702) 369-0396

## Taxonomy

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

## Other

- **Enumeration date:** 10/25/2007
- **Last updated:** 10/25/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 32-2D00000X | — | NV |