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General NPI Number Information
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NPI Number | 1942577994
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Entity Type | Organization
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Legal Business Name | BAMBOO SUNRISE LLC
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Dates
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Enumeration Date | 11/18/2011
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Last Update Date | 09/10/2021
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Provider Practice Location Address
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Address Line | 98 E LAKE MEAD PKWY STE 201
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City | HENDERSON
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State | NV
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Zip | 89015-6443
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Country | US
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Telephone | 702-433-3038
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Fax |
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Provider Business Mailing Address
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Address Line | 98 E LAKE MEAD PKWY STE 201
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City | HENDERSON
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State | NV
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Zip | 89015-6443
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Country | US
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Telephone | 702-433-3038
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | SHIRLEY LIM HOLDEMAN
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Credential |
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Telephone | 702-433-3038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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