Organization
CCA NETWORK INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDAL ARLILLIAN KELLY PHD (CLINICAL DIRECTOR)
(702) 255-0056
Entity
Organization
Contact information
Practice address
5836 S PECOS RD STE 102, LAS VEGAS, NV 89120-3418
(702) 255-0056
(702) 255-0076
Mailing address
5836 S PECOS RD STE 102, LAS VEGAS, NV 89120-3418
(702) 255-0056
(702) 255-0076
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699872614
NPPES
—
01
—
1760811798
NPPES
—
Enumeration date
06/06/2019
Last updated
06/06/2019
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