Healthcare Provider Details

I. General information

NPI: 1659766137
Provider Name (Legal Business Name): JUST LIKE FAMILY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 KRUGER CT
NORTH LAS VEGAS NV
89032-9005
US

IV. Provider business mailing address

1118 KRUGER CT
NORTH LAS VEGAS NV
89032-9005
US

V. Phone/Fax

Practice location:
  • Phone: 702-489-4503
  • Fax:
Mailing address:
  • Phone: 702-489-4503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberNV20141299285
License Number StateNV

VIII. Authorized Official

Name: ALFORTRA DIANE TURNER
Title or Position: MANAGER AGENT
Credential:
Phone: 702-489-4503