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NPI Code Detail

MEDICARE: APPLE GROVE TREATMENT CENTER

MEDICARE: APPLE GROVE TREATMENT CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
2251S00000XCommunity/Behavioral Health Agency
3101YM0800XMental Health Counselor
4101YA0400XAddiction (Substance Use Disorder) Counselor
5106H00000XMarriage & Family Therapist
61041C0700XClinical Social Worker
7253J00000XFoster Care Agency

General Provider Information

NPI Number : 1689852279
Entity Type Code : Organization
Provider Name (Legal Business Name) : APPLE GROVE TREATMENT CENTER
Provider Business Mailing Address
First Line : 8620 S EASTERN AVE # 16
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-2836
Country : US
Telephone Number : 702-992-0576
Fax Number : 702-992-0391
Provider Business Practice Location Address
First Line : 8620 S EASTERN AVE # 16
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-2836
Country : US
Telephone Number : 702-992-0576
Fax Number : 702-992-0391
Authorized Official
Title or Position : DIRECTOR
Name : MRS. ICIA SANDULAK
Credential :
Telephone Number : 702-992-0576
Provider Enumeration Date : 02/06/2008
Last Update Date : 08/09/2011

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Directions to “APPLE GROVE TREATMENT CENTER ” Practice Location

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