Healthcare Provider Details

I. General information

NPI: 1841825346
Provider Name (Legal Business Name): 702 POINT PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9856 POPLAR POINT AVE
LAS VEGAS NV
89178-6315
US

IV. Provider business mailing address

9856 POPLAR POINT AVE
LAS VEGAS NV
89178-6315
US

V. Phone/Fax

Practice location:
  • Phone: 702-328-4634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMBER SUAREZ
Title or Position: OWNER
Credential:
Phone: 702-328-4634