Healthcare Provider Details

I. General information

NPI: 1255390589
Provider Name (Legal Business Name): CLARK COUNTY DEPARTMENT OF JUVENILE JUSTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N PECOS RD
LAS VEGAS NV
89101-2408
US

IV. Provider business mailing address

601 N PECOS RD
LAS VEGAS NV
89101-2408
US

V. Phone/Fax

Practice location:
  • Phone: 702-455-6402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ALBERTO SANTA MARIA
Title or Position: SR. FINANCIAL OFFICE SPECIALIST
Credential:
Phone: 702-455-6402