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General NPI Number Information
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NPI Number | 1255096863
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Entity Type | Organization
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Legal Business Name | SOUTHWEST HEALTHCARE LLC
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 3277 W CRAIG RD STE 100-130
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-0792
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Country | US
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Telephone | 702-469-7897
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Fax |
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Provider Business Mailing Address
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Address Line | 3131 W CRAIG RD STE 180
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-0861
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Country | US
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Telephone | 702-469-7897
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BARBARA DEDEAUX
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Credential |
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Telephone | 702-469-7897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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