Organization
IDA'S HOUSE
Active
Organization
IDA'S HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE GLENN (CEO)
(702) 612-6787
Entity
Organization
Contact information
Practice address
4022 ALLYSON RAE ST, NORTH LAS VEGAS, NV 89032-0258
(702) 612-6787
Mailing address
8665 W FLAMINGO RD, STE # 131, LAS VEGAS, NV 89147-8621
(702) 612-6787
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
12/24/2014
Last updated
12/24/2014
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