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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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2253J00000XFoster Care AgencyNV
3106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1790063626
Entity Type Code : Organization
Provider Name (Legal Business Name) : APPLE GROVE TREATMENT CENTER
Provider Business Mailing Address
First Line : 3155 E PATRICK LN
Second Line : STE 1
City : LAS VEGAS
State : NV
Zip : 89120-3481
Country : US
Telephone Number : 702-992-0576
Fax Number : 702-992-0391
Provider Business Practice Location Address
First Line : 3155 E PATRICK LN
Second Line : STE 1
City : LAS VEGAS
State : NV
Zip : 89120-3481
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 : 702-576-7942
Provider Enumeration Date : 07/26/2011
Last Update Date : 08/01/2024

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Directions to “APPLE GROVE TREATMENT CENTER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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