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General NPI Number Information
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NPI Number | 1295136489
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Entity Type | Organization
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Legal Business Name | HOME OF POSSIBILITIES
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 8224 BRIGGS GULLY ST
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City | N LAS VEGAS
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State | NV
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Zip | 89085-4431
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Country | US
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Telephone | 702-575-7140
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Fax |
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Provider Business Mailing Address
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Address Line | 8224 BRIGGS GULLY ST
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City | N LAS VEGAS
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State | NV
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Zip | 89085-4431
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Country | US
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Telephone | 702-575-7140
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CORY BIENIEMY
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Credential |
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Telephone | 702-540-9011
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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 | 20091454427
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License Number State | NV
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