Healthcare Provider Details

I. General information

NPI: 1124289012
Provider Name (Legal Business Name): NEVADA CHILDREN'S CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5615 S PECOS RD
LAS VEGAS NV
89120-1961
US

IV. Provider business mailing address

5615 S PECOS RD
LAS VEGAS NV
89120-1961
US

V. Phone/Fax

Practice location:
  • Phone: 702-736-8100
  • Fax:
Mailing address:
  • Phone: 702-736-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: DONIELLE TWITTY-ALLEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-736-8100