Organization
DRIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT TAYLOR (CFO)
(702) 202-2998
Entity
Organization
Contact information
Practice address
304 S JONES BLVD # 8821, LAS VEGAS, NV 89107-2623
(702) 578-1933
Mailing address
304 S JONES BLVD # 8821, LAS VEGAS, NV 89107-2623
(702) 578-1933
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
253J00000X
Foster Care Agency
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
08/03/2023
Last updated
08/03/2023
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