Healthcare Provider Details

I. General information

NPI: 1104161355
Provider Name (Legal Business Name): EQUAL HOUSING OPPORTUNITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1264 MOON VISION ST
HENDERSON NV
89052-4007
US

IV. Provider business mailing address

1264 MOON VISION ST
HENDERSON NV
89052-4007
US

V. Phone/Fax

Practice location:
  • Phone: 702-491-1265
  • Fax: 702-453-8874
Mailing address:
  • Phone: 702-491-1265
  • Fax: 702-453-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNV

VIII. Authorized Official

Name: MRS. CONNIE LINNETTE HARRIS
Title or Position: PRESIDENT
Credential:
Phone: 702-491-1265