Healthcare Provider Details

I. General information

NPI: 1588112932
Provider Name (Legal Business Name): PRICE PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5576 CY YOUNG DR
LAS VEGAS NV
89110-5621
US

IV. Provider business mailing address

5576 CY YOUNG DR
LAS VEGAS NV
89110-5621
US

V. Phone/Fax

Practice location:
  • Phone: 702-444-6082
  • Fax: 702-446-8133
Mailing address:
  • Phone: 702-444-6080
  • Fax: 702-446-8133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS BRANDI ROCHELLE BROOKS
Title or Position: OWNER
Credential:
Phone: 702-444-6082