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General NPI Number Information
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NPI Number | 1871091959
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Entity Type | Organization
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Legal Business Name | GRIP FAMILY SERVICES LLC
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 6330 MCLEOD DR STE 3
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City | LAS VEGAS
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State | NV
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Zip | 89120-4431
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Country | US
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Telephone | 702-754-3484
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Fax | 702-629-7952
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Provider Business Mailing Address
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Address Line | 6330 MCLEOD DR STE 3
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City | LAS VEGAS
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State | NV
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Zip | 89120-4431
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Country | US
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Telephone | 702-824-3629
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Fax | 702-629-7952
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SHARONDA CONWAY
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Credential |
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Telephone | 702-824-3629
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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 | NV20171544329
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License Number State | NV
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