=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356932008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHELSEY'S HOME FOR PREGNANT TEENS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2021
-----------------------------------------------------
Last Update Date | 01/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3333 N MICHAEL WAY
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89108-4665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-918-7602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3333 N MICHAEL WAY
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89108-4665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-918-7602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | FAY WARREN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-918-7602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------