Organization
INDIGO SUPPORTIVE SERVICES LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARITTA WALLER (OWNER /OPERATOR)
(313) 656-8824
Entity
Organization
Contact information
Practice address
930 S. 4TH ST, STE 209 #3446, LAS VEGAS, NV 89101
(313) 656-8824
Mailing address
930 S. 4TH ST, STE 209 #3446, LAS VEGAS, NV 89101
(313) 656-8824
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
06/17/2024
Last updated
06/17/2024
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