Organization
QUALITY INDEPENDENT CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON RICHARD WATASE (OWNER)
(702) 400-3819
Entity
Organization
Contact information
Practice address
6298 MESOSPHERE CT, LAS VEGAS, NV 89110-5043
(702) 400-3819
Mailing address
2353 MOONLITE DR, LAS VEGAS, NV 89115-5305
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/12/2011
Last updated
09/12/2011
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