Healthcare Provider Details

I. General information

NPI: 1922548460
Provider Name (Legal Business Name): SPIRIT OF DAVID BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 SUN AVE APT B
N LAS VEGAS NV
89030-8176
US

IV. Provider business mailing address

2113 SUN AVE APT B
N LAS VEGAS NV
89030-8176
US

V. Phone/Fax

Practice location:
  • Phone: 702-957-8550
  • Fax:
Mailing address:
  • Phone: 702-957-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LAVELL WORTHY
Title or Position: MANAGER
Credential:
Phone: 702-957-8550