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General NPI Number Information
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NPI Number | 1760171938
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Entity Type | Organization
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Legal Business Name | BAMBOO SUNRISE LLC
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 6171 W CHARLESTON BLVD BLDG 11
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City | LAS VEGAS
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State | NV
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Zip | 89146-1126
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Country | US
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Telephone | 702-433-3038
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Fax |
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Provider Business Mailing Address
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Address Line | 98 E LAKE MEAD PKWY STE 201
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City | HENDERSON
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State | NV
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Zip | 89015-6443
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Country | US
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Telephone | 702-433-3038
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | SHIRLEY HOLDEMAN
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Credential |
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Telephone | 702-433-3038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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