Healthcare Provider Details

I. General information

NPI: 1023288875
Provider Name (Legal Business Name): THE PROMISE FOSTERCARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6008 FLY FISHER ST
LAS VEGAS NV
89113-1728
US

IV. Provider business mailing address

6008 FLY FISHER ST
LAS VEGAS NV
89113-1728
US

V. Phone/Fax

Practice location:
  • Phone: 702-655-5332
  • Fax:
Mailing address:
  • Phone: 702-655-5332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StateNV

VIII. Authorized Official

Name: VERNASSA WILLIAMS
Title or Position: MANAGER
Credential:
Phone: 702-655-5332