Organization
SOUL PROVIDER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATTIE SMITH (OWNER)
(775) 470-9718
Entity
Organization
Contact information
Practice address
3646 CAYMUS DR, SPARKS, NV 89436-7133
(775) 470-9718
Mailing address
3646 CAYMUS DR, SPARKS, NV 89436-7133
(775) 470-9718
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/14/2017
Last updated
04/23/2018
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