Organization
NEW VANATGE LLC
Active
Organization
NEW VANATGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHANIAN RICHBOW (MANAGER)
(313) 212-6733
Entity
Organization
Contact information
Practice address
9781 DOTTIE JEWEL AVE, LAS VEGAS, NV 89147-6766
(313) 212-6733
Mailing address
9781 DOTTIE JEWEL AVE, LAS VEGAS, NV 89147-6766
(313) 212-6733
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124383880
—
NV
05
—
1295098788
—
NV
05
—
1336492701
—
NV
05
—
1669735247
—
NV
05
—
1699872614
—
NV
Enumeration date
05/31/2013
Last updated
05/31/2013
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