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General NPI Number Information
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NPI Number | 1205079118
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Entity Type | Organization
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Legal Business Name | FAMILY IMPACT OF NEVADA
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 2513 BRAVE HEART AVE
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City | N LAS VEGAS
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State | NV
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Zip | 89031-0685
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Country | US
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Telephone | 702-883-9750
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Fax |
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Provider Business Mailing Address
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Address Line | 2513 BRAVE HEART AVE
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City | N LAS VEGAS
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State | NV
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Zip | 89031-0685
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Country | US
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Telephone | 702-883-9750
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MRS. CARMEA ANTASHA BASS
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Credential |
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Telephone | 702-883-9750
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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 |
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License Number State | NV
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