Organization
A.C.T.I.V.E
Active
Organization
A.C.T.I.V.E
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON MUKES (ASSISTANT DIRECTOR)
(702) 281-6560
Entity
Organization
Contact information
Practice address
5836 S PECOS RD, BUILDING D SUITE 101, LAS VEGAS, NV 89120-3418
(702) 281-6560
Mailing address
52 PROMINENT BLUFF CT, HENDERSON, NV 89002-3306
(702) 281-6560
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
NV20121132212
NV
253J00000X
Foster Care Agency
Primary
NV20121132212
NV
Other
Enumeration date
04/18/2012
Last updated
01/18/2013
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