Healthcare Provider Details

I. General information

NPI: 1811533763
Provider Name (Legal Business Name): READY FOR CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SOUTH 10TH STREET UNIT A
LAS VEGAS NV
89101-7874
US

IV. Provider business mailing address

510 SOUTH 10TH STREET UNIT A
LAS VEGAS NV
89101-7874
US

V. Phone/Fax

Practice location:
  • Phone: 702-462-6630
  • Fax:
Mailing address:
  • Phone: 702-462-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANISE MARIE ALEXANDER
Title or Position: DIRECTOR
Credential:
Phone: 800-207-1565