Organization
MYRACLE 1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA CLARK (CEO)
(702) 610-1715
Entity
Organization
Contact information
Practice address
3925 N MARTIN L KING BLVD STE 117, NORTH LAS VEGAS, NV 89032-7675
(702) 610-1715
Mailing address
3925 N MARTIN L KING BLVD STE 117, NORTH LAS VEGAS, NV 89032-7675
(702) 610-1715
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/03/2022
Last updated
10/03/2022
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