1417469826 NPI number — BROOKS FAMILY CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417469826 NPI number — BROOKS FAMILY CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKS FAMILY CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BROOKS ADDICTION AND COUNSELING MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417469826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3670 N RANCHO DRIVE
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89130-3174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-570-5200
Provider Business Mailing Address Fax Number:
702-473-5223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3550 W CHEYENNE AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89032-8212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-570-5200
Provider Business Practice Location Address Fax Number:
702-570-5201
Provider Enumeration Date:
10/26/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BROOKS
Authorized Official First Name:
DEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
702-910-5773

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3245S0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com