Organization
MOBILE MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ILLYAS MALIK JENKINS BS,QMHA (INDEPENDENT CONTRACTOR)
(702) 462-3604
Entity
Organization
Contact information
Practice address
736 HILL SHINE AVE, NORTH LAS VEGAS, NV 89031-2394
(702) 462-3604
Mailing address
736 HILL SHINE AVE, NORTH LAS VEGAS, NV 89031-2394
(702) 462-3604
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/05/2011
Last updated
02/05/2011
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