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General NPI Number Information
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NPI Number | 1720488299
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Entity Type | Organization
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Legal Business Name | GIANT STRIDES HEALTH SERVICES
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Dates
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Enumeration Date | 09/03/2014
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 730 N EASTERN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89101-2883
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Country | US
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Telephone | 702-683-6918
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Fax |
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Provider Business Mailing Address
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Address Line | 250 CLEARGIRL CT
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City | HENDERSON
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State | NV
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Zip | 89052-5920
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Country | US
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Telephone | 702-683-6918
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. JOSEPH WALTER GORMLEY
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Credential |
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Telephone | 702-683-6918
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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 |
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License Number State |
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