Healthcare Provider Details

I. General information

NPI: 1346429495
Provider Name (Legal Business Name): APPLE GROVE TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 WAVERLY CIR
HENDERSON NV
89014-4593
US

IV. Provider business mailing address

368 PLACER CREEK LN
HENDERSON NV
89014-4557
US

V. Phone/Fax

Practice location:
  • Phone: 702-369-0396
  • Fax:
Mailing address:
  • Phone: 702-369-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNV

VIII. Authorized Official

Name: ICIA REID SANDULAK
Title or Position: DIRECTOR
Credential: BSW
Phone: 702-369-0396