Organization
MOUNTAIN INTERVAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID CLARK (SUPERVISOR)
(702) 991-3150
Entity
Organization
Contact information
Practice address
4425 S JONES BLVD, D3, LAS VEGAS, NV 89103-3370
(702) 991-3150
Mailing address
4425 S JONES BLVD, D3, LAS VEGAS, NV 89103-3370
(702) 991-3150
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
X
NV
Other
Enumeration date
01/31/2014
Last updated
07/21/2022
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