Healthcare Provider Details

I. General information

NPI: 1649463761
Provider Name (Legal Business Name): PACIFIC ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2654 W HORIZON RIDGE PKWY # B5109
HENDERSON NV
89052-2803
US

IV. Provider business mailing address

2654 W HORIZON RIDGE PKWY # B5109
HENDERSON NV
89052-2803
US

V. Phone/Fax

Practice location:
  • Phone: 702-997-9600
  • Fax:
Mailing address:
  • Phone: 702-997-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICKY LEE
Title or Position: PRESIDENT
Credential:
Phone: 702-997-9600