Healthcare Provider Details

I. General information

NPI: 1689917049
Provider Name (Legal Business Name): BOYACK & ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 S JONES BLVD SUITE C
LAS VEGAS NV
89146-5656
US

IV. Provider business mailing address

PO BOX 82045
LAS VEGAS NV
89180-2045
US

V. Phone/Fax

Practice location:
  • Phone: 702-325-5928
  • Fax: 702-876-9110
Mailing address:
  • Phone: 702-325-5928
  • Fax: 702-876-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberNV20031426719
License Number StateNV

VIII. Authorized Official

Name: MR. NATHAN DOUGLAS BOYACK
Title or Position: PRESIDENT
Credential:
Phone: 702-325-5928