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NPI Code Detail

MEDICARE: INDEPENDENT CHOICES FOR SUCCESS COMMUNITY DEVELOPMENT CORPORATION

MEDICARE: INDEPENDENT CHOICES FOR SUCCESS COMMUNITY DEVELOPMENT CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251300000XLocal Education Agency (LEA)
2251B00000XCase Management Agency
3251V00000XVoluntary or Charitable Agency
4261QF0050XNon-Surgical Family Planning Clinic/Center
5261QG0250XGenetics Clinic/Center
6261QH0100XHealth Service Clinic/Center
7347C00000XPrivate Vehicle
81041C0700XClinical Social Worker
9103TH0100XHealth Service Psychologist
10106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1801109418
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDEPENDENT CHOICES FOR SUCCESS COMMUNITY DEVELOPMENT CORPORATION
Provider Business Mailing Address
First Line : 320 PRINCESS AVE
Second Line :
City : N LAS VEGAS
State : NV
Zip : 89030-3809
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 320 PRINCESS AVE
Second Line :
City : N LAS VEGAS
State : NV
Zip : 89030-3809
Country : US
Telephone Number : 702-573-5812
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : PHYLLIS JONES-JEFFERSON
Credential :
Telephone Number : 702-573-5812
Provider Enumeration Date : 07/23/2010
Last Update Date : 05/27/2011

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Directions to “INDEPENDENT CHOICES FOR SUCCESS COMMUNITY DEVELOPMENT CORPORATION ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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