Healthcare Provider Details

I. General information

NPI: 1023449089
Provider Name (Legal Business Name): DELALI MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 08/01/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 S JONES BLVD STE 2F
LAS VEGAS NV
89146-5604
US

IV. Provider business mailing address

6121 MEADOW VIEW LN
LAS VEGAS NV
89103-1121
US

V. Phone/Fax

Practice location:
  • Phone: 702-806-9143
  • Fax: 186-628-0947
Mailing address:
  • Phone: 702-806-9143
  • Fax: 186-628-0947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5116S
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. AYELE E AMAVIGAN
Title or Position: EXECUTIVE DIRECTOR/OWNER
Credential: ED.D, MSW, LCSW
Phone: 702-806-9143