Healthcare Provider Details

I. General information

NPI: 1548722143
Provider Name (Legal Business Name): FIRST STEP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 GRANT DR STE I
RENO NV
89509-5360
US

IV. Provider business mailing address

PO BOX 7201
RENO NV
89510-7201
US

V. Phone/Fax

Practice location:
  • Phone: 775-560-3821
  • Fax:
Mailing address:
  • Phone: 775-560-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES GIBNEY
Title or Position: OWNER
Credential:
Phone: 775-560-3821