Healthcare Provider Details

I. General information

NPI: 1164190997
Provider Name (Legal Business Name): ONE COMMUNITY OF SOUTHERN NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 W OWENS AVE STE 1
LAS VEGAS NV
89106-2451
US

IV. Provider business mailing address

2412 MARVELOUS MANOR AVE
NORTH LAS VEGAS NV
89032-1442
US

V. Phone/Fax

Practice location:
  • Phone: 203-578-6478
  • Fax:
Mailing address:
  • Phone: 203-578-6478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LATOSHA BONAPARTE-VIRGIL
Title or Position: DIRECTOR
Credential:
Phone: 203-578-6478