Healthcare Provider Details

I. General information

NPI: 1841843190
Provider Name (Legal Business Name): NIGHT OWL CRISIS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 SHIELD ST
N LAS VEGAS NV
89030-3891
US

IV. Provider business mailing address

2701 SHIELD ST
N LAS VEGAS NV
89030-3891
US

V. Phone/Fax

Practice location:
  • Phone: 725-400-8328
  • Fax:
Mailing address:
  • Phone: 725-400-8328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BRIAN LEE WHITTLE
Title or Position: OWNER
Credential:
Phone: 725-400-8328