Organization
DOVES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRIONNA WILLIAMS (DIRECTOR)
(702) 808-1261
Entity
Organization
Contact information
Practice address
3053 W CRAIG RD, NORTH LAS VEGAS, NV 89032-5124
(702) 808-1261
Mailing address
3717 KING CHARLES ST, NORTH LAS VEGAS, NV 89030-4422
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
302F00000X
Exclusive Provider Organization
—
—
Other
Enumeration date
03/15/2012
Last updated
03/15/2012
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