Healthcare Provider Details

I. General information

NPI: 1871204073
Provider Name (Legal Business Name): ASD.ME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10245 JERSEY SHORE AVE
LAS VEGAS NV
89135-1153
US

IV. Provider business mailing address

10245 JERSEY SHORE AVE
LAS VEGAS NV
89135-1153
US

V. Phone/Fax

Practice location:
  • Phone: 646-645-2108
  • Fax:
Mailing address:
  • Phone: 646-645-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL E JOHNSON
Title or Position: MANAGING MEMBER
Credential:
Phone: 646-645-2108