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NPI Code Detail

MEDICARE: BERGDALE & HALL, LLC

MEDICARE: BERGDALE & HALL, LLC
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
11041C0700XClinical Social Worker5554-CNV

General Provider Information

NPI Number : 1972814630
Entity Type Code : Organization
Provider Name (Legal Business Name) : BERGDALE & HALL, LLC
Provider Business Mailing Address
First Line : 6879 W CHARLESTON BLVD
Second Line : SUITE A
City : LAS VEGAS
State : NV
Zip : 89117-1672
Country : US
Telephone Number : 702-308-4807
Fax Number : 702-479-7173
Provider Business Practice Location Address
First Line : 6879 W CHARLESTON BLVD
Second Line : SUITE A
City : LAS VEGAS
State : NV
Zip : 89117-1672
Country : US
Telephone Number : 702-308-4807
Fax Number : 702-479-7173
Authorized Official
Title or Position : CO-OWNER
Name : SOMMER THYME BERGDALE
Credential : MA.
Telephone Number : 702-376-0024
Provider Enumeration Date : 06/28/2010
Last Update Date : 09/19/2016

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Directions to “BERGDALE & HALL, LLC ” Practice Location

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