Healthcare Provider Details

I. General information

NPI: 1598182172
Provider Name (Legal Business Name): FOUNDATION FOR POSITIVELY KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 E TOMPKINS AVE STE 222
LAS VEGAS NV
89121-7625
US

IV. Provider business mailing address

2480 E TOMPKINS AVE STE 222
LAS VEGAS NV
89121-7625
US

V. Phone/Fax

Practice location:
  • Phone: 702-262-0037
  • Fax: 702-262-0252
Mailing address:
  • Phone: 702-262-0037
  • Fax: 702-262-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number5551HHA-5
License Number StateNV

VIII. Authorized Official

Name: JUDY A NEW
Title or Position: VICE PRESIDENT MEDICAL CLINICS
Credential:
Phone: 702-455-5639