Healthcare Provider Details

I. General information

NPI: 1588222871
Provider Name (Legal Business Name): PRODUCTIVE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4496 N RANCHO DR STE E1
LAS VEGAS NV
89130-3406
US

IV. Provider business mailing address

1517 SANTA ROSALIA DR
NORTH LAS VEGAS NV
89031-1010
US

V. Phone/Fax

Practice location:
  • Phone: 702-929-3297
  • Fax:
Mailing address:
  • Phone: 702-929-3297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE NELSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-929-3297