Organization
APPLE GROVE TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ICIA REID SANDULAK BSW (DIRECTOR)
(702) 369-0396
Entity
Organization
Contact information
Practice address
2060 WAVERLY CIR, HENDERSON, NV 89014-4593
(702) 369-0396
Mailing address
368 PLACER CREEK LN, HENDERSON, NV 89014-4557
(702) 369-0396
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32-2D00000X
—
NV
Enumeration date
10/25/2007
Last updated
10/25/2007
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