Healthcare Provider Details

I. General information

NPI: 1962804468
Provider Name (Legal Business Name): FOUNDATION FOR POSITIVELY KIDS, A NONPROFIT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N PECOS RD
LAS VEGAS NV
89101-2400
US

IV. Provider business mailing address

4375 LAS VEGAS BLVD N STE 10
LAS VEGAS NV
89115-0587
US

V. Phone/Fax

Practice location:
  • Phone: 702-262-0037
  • Fax: 702-476-9122
Mailing address:
  • Phone: 702-620-0372
  • Fax: 702-272-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number19991199570
License Number StateNV

VIII. Authorized Official

Name: JEANETTE SMITH
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 702-262-0037