Healthcare Provider Details

I. General information

NPI: 1447722764
Provider Name (Legal Business Name): VMAE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 MONTESSOURI ST STE 200
LAS VEGAS NV
89117-3060
US

IV. Provider business mailing address

2575 MONTESSOURI ST STE 200
LAS VEGAS NV
89117-3060
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-5020
  • Fax: 702-485-5083
Mailing address:
  • Phone: 702-485-5020
  • Fax: 702-485-5083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA M KENDRID
Title or Position: PRESIDENT
Credential:
Phone: 702-859-9203