Healthcare Provider Details

I. General information

NPI: 1144196353
Provider Name (Legal Business Name): COMPREHENSIVE COMMUNITY HEALTH CENTERS - NEVADA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S BUFFALO DR STE 170
LAS VEGAS NV
89117-8329
US

IV. Provider business mailing address

1250 S BUFFALO DR STE 170
LAS VEGAS NV
89117-8329
US

V. Phone/Fax

Practice location:
  • Phone: 818-630-6106
  • Fax: 818-844-5085
Mailing address:
  • Phone: 818-630-6106
  • Fax: 818-844-5085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FLORA POLADYAN
Title or Position: COO
Credential:
Phone: 818-630-6106