1275876757 NPI number — MISSION FAMILY SERVICES

Table of content: (NPI 1275876757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275876757 NPI number — MISSION FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSION FAMILY SERVICES
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:
Provider Other Organization Name Type Code:
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:
1275876757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8670 W CHEYENNE AVENUE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89129-7457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-518-0863
Provider Business Mailing Address Fax Number:
702-644-0652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3417 OSIANA AVE
Provider Second Line Business Practice Location Address:
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:
89031-7236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-232-4380
Provider Business Practice Location Address Fax Number:
702-644-0652
Provider Enumeration Date:
04/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
SHELL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
702-232-4380

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  NV20131118652 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 082 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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