Organization
IGNITE TEEN TREATMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA MARSHALL (DIRECTOR OF BILLING)
(570) 203-9222
Entity
Organization
Contact information
Practice address
7390 EDNA AVE, LAS VEGAS, NV 89117-2902
(570) 203-9222
(570) 203-9477
Mailing address
512 NORTHAMPTON ST # 158, EDWARDSVILLE, PA 18704-4560
(570) 203-9222
(570) 203-9477
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/20/2023
Last updated
11/20/2023
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