Organization
PASSPORT TO INDEPENDENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE COLES (MANAGER)
(702) 504-5020
Entity
Organization
Contact information
Practice address
580 W CHEYENNE AVE STE 40, NORTH LAS VEGAS, NV 89030-3978
(702) 462-6692
Mailing address
580 W CHEYENNE AVE STE 40, NORTH LAS VEGAS, NV 89030-3978
(702) 462-6692
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/27/2017
Last updated
10/15/2019
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