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General NPI Number Information
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NPI Number | 1689170862
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Entity Type | Organization
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Legal Business Name | CYCLES OF CHANGE RECOVERY SERVICES, LLC
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 6069 S FORT APACHE RD STE 130
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City | LAS VEGAS
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State | NV
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Zip | 89148-5579
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Country | US
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Telephone | 702-749-5913
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Fax |
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Provider Business Mailing Address
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Address Line | 6069 S FORT APACHE RD STE 130
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City | LAS VEGAS
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State | NV
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Zip | 89148-5579
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATION MANAGER
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Name | JOSEPH HUNTER
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Credential |
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Telephone | 818-497-8177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | NV20171772492
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License Number State | NV
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