Healthcare Provider Details

I. General information

NPI: 1396166310
Provider Name (Legal Business Name): NEW START AT SECOND CHANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 JEFFERSON AVE
LAS VEGAS NV
89106-2833
US

IV. Provider business mailing address

1201 JEFFERSON AVE
LAS VEGAS NV
89106-2833
US

V. Phone/Fax

Practice location:
  • Phone: 702-528-3240
  • Fax:
Mailing address:
  • Phone: 702-528-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CLIFFORD OSLEY
Title or Position: CEO
Credential:
Phone: 702-528-3240