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Organization

UNEPECTED CHANGES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JACQUELINE C EDWARDS (CEO/OWNER)
(702) 353-2467
Entity
Organization

Contact information

Practice address
428 MARION DR, LAS VEGAS, NV 89110-3473
(702) 353-2467
Mailing address
4701 LAWRENCE ST UNIT 1138, NORTH LAS VEGAS, NV 89081-4200
(702) 353-2467

Taxonomy

Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary

Other

Enumeration date
04/01/2010
Last updated
04/01/2010
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