Healthcare Provider Details

I. General information

NPI: 1407158942
Provider Name (Legal Business Name): UNLIMITED POSSIBILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6771 WEST CHARLESTON BLVD. SUITE C
LAS VEGAS NV
89146
US

IV. Provider business mailing address

PO BOX 370724
LAS VEGAS NV
89137
US

V. Phone/Fax

Practice location:
  • Phone: 702-467-1377
  • Fax: 702-823-4781
Mailing address:
  • Phone: 702-467-1377
  • Fax: 702-586-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberNV 20101552416
License Number StateNV

VIII. Authorized Official

Name: RYAN BRENDON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-467-1377