Healthcare Provider Details

I. General information

NPI: 1689852279
Provider Name (Legal Business Name): APPLE GROVE TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8620 S EASTERN AVE # 16
LAS VEGAS NV
89123-2836
US

IV. Provider business mailing address

8620 S EASTERN AVE # 16
LAS VEGAS NV
89123-2836
US

V. Phone/Fax

Practice location:
  • Phone: 702-992-0576
  • Fax: 702-992-0391
Mailing address:
  • Phone: 702-992-0576
  • Fax: 702-992-0391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ICIA SANDULAK
Title or Position: DIRECTOR
Credential:
Phone: 702-992-0576