Healthcare Provider Details

I. General information

NPI: 1871865386
Provider Name (Legal Business Name): DARK KNIGHT OSO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W SAHARA AVE SUITE 420
LAS VEGAS NV
89102-4352
US

IV. Provider business mailing address

2300 W SAHARA AVE SUITE 420
LAS VEGAS NV
89102-4352
US

V. Phone/Fax

Practice location:
  • Phone: 702-754-5255
  • Fax: 702-750-9652
Mailing address:
  • Phone: 702-754-5255
  • Fax: 702-750-9652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberNV20121035663
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberNV20121035663
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. THERON WARD
Title or Position: CFO
Credential:
Phone: 702-717-6971