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General NPI Number Information
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NPI Number | 1821531732
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Entity Type | Organization
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Legal Business Name | COMFORT CARE CLINIC LLC
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Dates
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Enumeration Date | 11/24/2016
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Last Update Date | 11/24/2016
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Provider Practice Location Address
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Address Line | 2121 N JONES BLVD #206
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City | LAS VEGAS
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State | NV
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Zip | 89108-3300
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Country | US
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Telephone | 404-754-2933
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 N JONES BLVD #206
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City | LAS VEGAS
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State | NV
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Zip | 89108-3300
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Country | US
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Telephone | 404-754-2933
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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 | MS. DYAN E WEBB
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Credential |
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Telephone | 404-754-2933
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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 | NV20161596632
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License Number State | NV
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