Organization
CONFUZION52
Active
Other names
TEEN FUZION
Organization subpart
No
Provider details
NPI number
Authorized official
EILA R GREGORY (COMMUNITY HEALTH REPRESENTATIVE)
(702) 633-9196
Entity
Organization
Contact information
Practice address
531 BLACKBIRD KNOLL CT, NORTH LAS VEGAS, NV 89084-1316
(702) 633-9196
Mailing address
PO BOX 336514, NORTH LAS VEGAS, NV 89033-6514
(702) 633-9196
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/09/2011
Last updated
11/09/2011
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