Organization
BUILDING INTELLIGENT GENERATIONS III
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY JOHSNON (CEO)
(702) 883-9591
Entity
Organization
Contact information
Practice address
4080 PARADISE RD, 15-297, LAS VEGAS, NV 89169-4834
(702) 883-9591
(702) 685-8309
Mailing address
4080 PARADISE RD, 15-297, LAS VEGAS, NV 89169-4834
(702) 685-7944
(702) 685-8309
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100510961
—
NV
Enumeration date
06/29/2007
Last updated
04/29/2008
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