Healthcare Provider Details

I. General information

NPI: 1609285014
Provider Name (Legal Business Name): THE GATEWAY CENTER LAS VEGAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 N PECOS RD SUITE C
HENDERSON NV
89074-7343
US

IV. Provider business mailing address

74 N PECOS RD SUITE C
HENDERSON NV
89074-7343
US

V. Phone/Fax

Practice location:
  • Phone: 702-778-4500
  • Fax: 702-778-3500
Mailing address:
  • Phone: 702-778-4500
  • Fax: 702-778-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberNV20141465166
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberNV20141465166
License Number StateNV

VIII. Authorized Official

Name: MEREDITH MILNE STILL
Title or Position: DIRECTOR OF HUMAN RESOURCES
Credential:
Phone: 702-420-0919