Healthcare Provider Details

I. General information

NPI: 1194199687
Provider Name (Legal Business Name): PEACE AND TRANQUILITY RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9788 GILESPIE ST STE 424
LAS VEGAS NV
89183
US

IV. Provider business mailing address

9788 GILESPIE ST STE 424
LAS VEGAS NV
89183-7611
US

V. Phone/Fax

Practice location:
  • Phone: 792-902-2362
  • Fax:
Mailing address:
  • Phone: 702-902-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberNV20151125507
License Number StateNV

VIII. Authorized Official

Name: MR. RAFAEL D SCROGGINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-902-2362