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General NPI Number Information
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NPI Number | 1760852453
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Entity Type | Organization
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Legal Business Name | TADAAZ 360 INC
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 2350 S JONES BLVD 226
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City | LAS VEGAS
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State | NV
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Zip | 89146-3103
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Country | US
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Telephone | 702-215-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 S. JONES BLVD. SUITE 226
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City | LAS VEGAS
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State | NV
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Zip | 89146
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Country | US
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Telephone | 702-215-5800
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ARTAVIA WOMACK WILSON
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Credential | B.S.
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Telephone | 702-339-7883
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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 | NV201412822800
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License Number State | NV
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