Healthcare Provider Details

I. General information

NPI: 1851071096
Provider Name (Legal Business Name): CREDREV PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 10/21/2023
Certification Date: 10/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 W HORIZON RIDGE PKWY STE 101
HENDERSON NV
89052-2870
US

IV. Provider business mailing address

PO BOX 777698
HENDERSON NV
89077-7698
US

V. Phone/Fax

Practice location:
  • Phone: 877-795-2361
  • Fax: 888-522-7319
Mailing address:
  • Phone: 877-795-2361
  • Fax: 888-522-7319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: KANDY MORRIS
Title or Position: PRESIDENT
Credential:
Phone: 877-795-2361