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General NPI Number Information
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NPI Number | 1174942809
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Entity Type | Organization
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Legal Business Name | THE GRADUATE HOUSE
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 5812 GOLD HORIZON ST
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-6881
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Country | US
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Telephone | 702-502-0647
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Fax |
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Provider Business Mailing Address
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Address Line | 5812 GOLD HORIZON ST
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-6881
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Country | US
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Telephone | 702-502-0647
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEVIN BRINTON COOK
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Credential |
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Telephone | 702-502-0647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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