Organization
WYATT HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LC DIZON (MANAGING MEMBER)
(702) 569-6148
Entity
Organization
Contact information
Practice address
1113 WYATT AVE, LAS VEGAS, NV 89106-2440
(702) 888-1312
Mailing address
1113 WYATT AVE, LAS VEGAS, NV 89106-2440
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/14/2026
Last updated
04/14/2026
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