Healthcare Provider Details

I. General information

NPI: 1154664464
Provider Name (Legal Business Name): LAS VEGAS INDIAN CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W BONANZA RD
LAS VEGAS NV
89106-4718
US

IV. Provider business mailing address

2300 W BONANZA RD
LAS VEGAS NV
89106-4718
US

V. Phone/Fax

Practice location:
  • Phone: 702-647-5842
  • Fax:
Mailing address:
  • Phone: 702-647-5842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberN35-00001-I-125420
License Number StateNV

VIII. Authorized Official

Name: DEBRA REED
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-647-5842