Healthcare Provider Details

I. General information

NPI: 1619253598
Provider Name (Legal Business Name): HATTIE'S HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 COLLEGE DR # 1312
HENDERSON NV
89015-1532
US

IV. Provider business mailing address

PO BOX 73032
LAS VEGAS NV
89170-3032
US

V. Phone/Fax

Practice location:
  • Phone: 702-522-0568
  • Fax: 702-522-0568
Mailing address:
  • Phone: 702-522-0568
  • Fax: 702-522-0568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. WACONDA J ALVAREZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-522-0568