Healthcare Provider Details

I. General information

NPI: 1770079311
Provider Name (Legal Business Name): UNDER 1 UMBRELLA CDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 PENNWOOD AVE STE 115
LAS VEGAS NV
89102-0431
US

IV. Provider business mailing address

848 N RAINBOW BLVD # 54
LAS VEGAS NV
89107-1103
US

V. Phone/Fax

Practice location:
  • Phone: 702-201-5192
  • Fax:
Mailing address:
  • Phone: 702-201-5192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNV

VIII. Authorized Official

Name: CEDRA PERRY
Title or Position: OWNER
Credential:
Phone: 702-201-5192