Organization
AN OPEN DOOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL J COOKS (OWNER)
(702) 580-0177
Entity
Organization
Contact information
Practice address
4804 LUFKIN AVE, LAS VEGAS, NV 89130-3038
(702) 580-0177
Mailing address
4804 LUFKIN AVE, LAS VEGAS, NV 89130-3038
(702) 580-0177
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
01/22/2014
Last updated
01/22/2014
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