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Active
Organization subpart
No

Provider details

NPI number
Authorized official
CORY BIENIEMY (OWNER)
(702) 540-9011
Entity
Organization

Contact information

Practice address
8224 BRIGGS GULLY ST, N LAS VEGAS, NV 89085-4431
(702) 575-7140
Mailing address
8224 BRIGGS GULLY ST, N LAS VEGAS, NV 89085-4431
(702) 575-7140

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
20091454427
NV

Other

Enumeration date
09/08/2014
Last updated
09/08/2014
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