Healthcare Provider Details

I. General information

NPI: 1518473032
Provider Name (Legal Business Name): GOLD CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 S DECATUR BLVD STE 3010
LAS VEGAS NV
89103-6814
US

IV. Provider business mailing address

3885 S DECATUR BLVD STE 3010
LAS VEGAS NV
89103-6814
US

V. Phone/Fax

Practice location:
  • Phone: 702-875-6618
  • Fax: 702-875-6618
Mailing address:
  • Phone: 702-875-6618
  • Fax: 702-566-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6823C
License Number StateNV

VIII. Authorized Official

Name: LAUREY RAY
Title or Position: BILLING MANAGER
Credential: CMBS
Phone: 702-268-5067