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General NPI Number Information
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NPI Number | 1316560774
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Entity Type | Organization
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Legal Business Name | CENTER FOR LIFE-CARE
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 155 CADILLAC PL
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City | RENO
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State | NV
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Zip | 89509-4355
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Country | US
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Telephone | 702-503-3382
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20074
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City | LAS VEGAS
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State | NV
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Zip | 89112-2074
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Country | US
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Telephone | 702-569-2250
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | WILLIAM JOHN WYNN
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Credential |
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Telephone | 775-762-7903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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