Healthcare Provider Details

I. General information

NPI: 1366477036
Provider Name (Legal Business Name): NEVADA FAMILY PRACTICE RESIDENCY PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E CHARLESTON BLVD SUITE 230
LAS VEGAS NV
89104-6659
US

IV. Provider business mailing address

4000 E CHARLESTON BLVD SUITE 230
LAS VEGAS NV
89104-6659
US

V. Phone/Fax

Practice location:
  • Phone: 702-968-5059
  • Fax: 702-968-4041
Mailing address:
  • Phone: 702-968-5059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES R PARCELLS
Title or Position: PRESIDENT
Credential: LISW
Phone: 702-968-5059