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General NPI Number Information
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NPI Number | 1598045064
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Entity Type | Organization
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Legal Business Name | ST BENEDICT
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Dates
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Enumeration Date | 08/27/2011
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Last Update Date | 08/27/2011
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Provider Practice Location Address
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Address Line | 3625 ROSEWOOD DR
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City | LAS VEGAS
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State | NV
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Zip | 89121-3261
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Country | US
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Telephone | 702-454-0532
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Fax | 702-454-0532
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Provider Business Mailing Address
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Address Line | 145 BROKEN TEE DR
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City | HENDERSON
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State | NV
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Zip | 89074-8324
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Country | US
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Telephone | 702-454-1203
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Fax | 702-454-1203
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Authorized Official
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Title or Position | OWNER
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Name | ROSELYN R JAVIER
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Credential |
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Telephone | 702-454-1203
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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 | 1000234-706
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License Number State | NV
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