Organization
READY FOR CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANISE MARIE ALEXANDER (DIRECTOR)
(800) 207-1565
Entity
Organization
Contact information
Practice address
510 SOUTH 10TH STREET, UNIT A, LAS VEGAS, NV 89101-7874
(702) 462-6630
Mailing address
510 SOUTH 10TH STREET, UNIT A, LAS VEGAS, NV 89101-7874
(702) 462-6630
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1366082471
INDIVIDUAL
—
Enumeration date
11/25/2019
Last updated
01/25/2023
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