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General NPI Number Information
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NPI Number | 1780823930
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Entity Type | Organization
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Legal Business Name | NEW LEVELS COMMUNITY DEVELOPMENT
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 3880 LEISURE LN
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City | LAS VEGAS
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State | NV
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Zip | 89103-2337
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Country | US
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Telephone | 702-510-2642
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20074
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City | LAS VEGAS
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State | NV
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Zip | 89112-2074
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Country | US
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Telephone | 702-510-2642
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. EDITH MONIQUE WYNN
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Credential |
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Telephone | 702-510-2642
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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 | C301272003
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License Number State | NV
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