Organization
SUPER YOUTH OF NEVADA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEMETRIUS JEMIL HUNTER (MANAGER)
(702) 748-1508
Entity
Organization
Contact information
Practice address
867 WORRELL AVE, LAS VEGAS, NV 89123-3183
(702) 748-1508
Mailing address
867 WORRELL AVE., LAS VEGAS, NV 89123-3183
(702) 748-1508
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
NV
Other
Enumeration date
01/27/2012
Last updated
04/11/2012
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