Organization
PARADISE RANCH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL DONALD ROGERS III (DIRECTOR)
(702) 515-7117
Entity
Organization
Contact information
Practice address
1722 PRIMROSE PATH, LAS VEGAS, NV 89108-1918
(702) 515-7117
Mailing address
1722 PRIMROSE PATH, LAS VEGAS, NV 89108-1918
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447519095
—
NV
Enumeration date
12/19/2012
Last updated
12/19/2012
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