Organization
WICKER BASKET LLC
Active
Other names
Wicker Basket
Organization subpart
No
Provider details
NPI number
Authorized official
LOURDES MANGUINO (OWNWE)
(702) 445-0088
Entity
Organization
Contact information
Practice address
3020 BEAUFORT CT, NORTH LAS VEGAS, NV 89032-0478
(702) 994-0857
Mailing address
3020 BEAUFORT CT, NORTH LAS VEGAS, NV 89032-0478
(702) 445-0088
(702) 476-8933
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
—
—
Other
Enumeration date
06/07/2018
Last updated
10/15/2020
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