Organization
ELEVATE LIFE FAMILY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WILLIE PEARL JACKSON (OWNER)
(702) 630-5009
Entity
Organization
Contact information
Practice address
2605 RAINBOW GLOW ST, NORTH LAS VEGAS, NV 89030-3709
(702) 630-5009
Mailing address
2605 RAINBOW GLOW ST, NORTH LAS VEGAS, NV 89030-3709
(702) 630-5009
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932500000X
—
NV
Enumeration date
06/20/2012
Last updated
06/20/2012
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