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General NPI Number Information
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NPI Number | 1508567595
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Entity Type | Organization
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Legal Business Name | HEALTHY COMMUNITIES COALITION
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Dates
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Enumeration Date | 03/15/2023
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 209 DAYTON VALLEY RD
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City | DAYTON
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State | NV
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Zip | 89403-8919
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Country | US
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Telephone | 775-246-7550
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 517
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City | DAYTON
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State | NV
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Zip | 89403-0517
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Country | US
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Telephone | 775-246-7550
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Fax |
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Authorized Official
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Title or Position | PROJECT DIRECTOR
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Name | KODI DETTLING
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Credential |
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Telephone | 775-246-7550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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