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General NPI Number Information
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NPI Number | 1922453448
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Entity Type | Organization
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Legal Business Name | DESERT STATE DAY TREATMENT CENTER LLC
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 05/03/2016
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Provider Practice Location Address
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Address Line | 6396 MCLEOD DR STE 6
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City | LAS VEGAS
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State | NV
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Zip | 89120-4429
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Country | US
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Telephone | 702-556-8102
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Fax |
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Provider Business Mailing Address
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Address Line | 11389 OGDEN MILLS DR UNIT 103
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City | LAS VEGAS
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State | NV
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Zip | 89135-3324
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Country | US
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Telephone | 702-556-8102
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. IMANI BUTLER
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Credential |
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Telephone | 702-556-8102
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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 | NV20161177555
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License Number State | NV
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