Healthcare Provider Details

I. General information

NPI: 1114701760
Provider Name (Legal Business Name): STRONGBRIDGE INTEGRATED SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4442 AVERY PARK AVE
LAS VEGAS NV
89110-5488
US

IV. Provider business mailing address

4442 AVERY PARK AVE
LAS VEGAS NV
89110-5488
US

V. Phone/Fax

Practice location:
  • Phone: 702-541-4817
  • Fax:
Mailing address:
  • Phone: 702-541-4817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. OLUGBENGA AKINWALE OBAJUWONLO
Title or Position: CEO
Credential: MD
Phone: 702-934-0219