Healthcare Provider Details

I. General information

NPI: 1770220162
Provider Name (Legal Business Name): CIVICA CAREER AND COLLEGIATE ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E CAREY AVE
NORTH LAS VEGAS NV
89030-5766
US

IV. Provider business mailing address

1501 E CAREY AVE
NORTH LAS VEGAS NV
89030-5766
US

V. Phone/Fax

Practice location:
  • Phone: 702-452-9653
  • Fax:
Mailing address:
  • Phone: 702-452-9653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL THIRIOT
Title or Position: DIRECTOR OF SPECIAL PROJECTS
Credential:
Phone: 702-423-3348