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General NPI Number Information
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NPI Number | 1780177626
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Entity Type | Organization
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Legal Business Name | BACK ON TRACK HEALTH SERVICES INC
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 2780 S JONES BLVD STE 2003120
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City | LAS VEGAS
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State | NV
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Zip | 89146-5628
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Country | US
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Telephone | 702-379-8926
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Fax |
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Provider Business Mailing Address
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Address Line | 2780 S JONES BLVD STE 2003120
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City | LAS VEGAS
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State | NV
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Zip | 89146-5628
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Country | US
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Telephone | 702-379-8926
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. NICOLE CHAVEZ
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Credential |
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Telephone | 702-379-8926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | NV20181391287
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License Number State | NV
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