Healthcare Provider Details

I. General information

NPI: 1023400652
Provider Name (Legal Business Name): COPES COMFORT CARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 W OWENS AVE STE 6
LAS VEGAS NV
89106-2451
US

IV. Provider business mailing address

1240 W OWENS AVE STE 3
LAS VEGAS NV
89106-2452
US

V. Phone/Fax

Practice location:
  • Phone: 702-636-5373
  • Fax:
Mailing address:
  • Phone: 702-636-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberAPN00370
License Number StateNV

VIII. Authorized Official

Name: STEPHANIE ROSS
Title or Position: EXECUTIVE DIRERECTOR
Credential:
Phone: 702-636-5373