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General NPI Number Information
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NPI Number | 1265142590
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Entity Type | Organization
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Legal Business Name | WAY OF LIFE COMMUNITY SERVICES
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 245 SERENITY RIDGE CT
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City | HENDERSON
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State | NV
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Zip | 89052-5913
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Country | US
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Telephone | 702-406-9879
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Fax |
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Provider Business Mailing Address
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Address Line | 245 SERENITY RIDGE CT
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City | HENDERSON
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State | NV
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Zip | 89052-5913
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Country | US
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Telephone | 702-406-9879
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. ANGELIQUE CHALALA
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Credential | MS
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Telephone | 702-406-9879
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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 |
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