# IGNITE TEEN TREATMENT LLC

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

## Provider details

- **NPI number:** 1932974995
- **Authorized official:** MELISSA MARSHALL (DIRECTOR OF BILLING)
- **Authorized official phone:** (570) 203-9222

## Contact information

- **Practice address:** 7390 EDNA AVE, LAS VEGAS, NV 89117-2902
- **Practice address phone:** (570) 203-9222
- **Practice address fax:** (570) 203-9477
- **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 |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/20/2023
- **Last updated:** 11/20/2023