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General NPI Number Information
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NPI Number | 1053792879
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Entity Type | Organization
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Legal Business Name | BLUECOVE HOMES LLC
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 9535 SCOTTVILLE CT
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City | LAS VEGAS
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State | NV
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Zip | 89148-4621
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Country | US
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Telephone | 702-834-4307
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Fax | 702-485-4437
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Provider Business Mailing Address
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Address Line | 9535 SCOTTVILLE CT
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City | LAS VEGAS
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State | NV
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Zip | 89148-4621
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Country | US
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Telephone | 702-834-4307
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Fax | 702-485-4437
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | MS. STACEY SUZANNE PAYNE
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Credential | CADC
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Telephone | 702-834-4307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 20140769237-41
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License Number State | NV
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