1437561826 NPI number — OPPORTUNITY VILLAGE ASSOCIATION FOR RETARDED CITIZENS

Table of content: (NPI 1437561826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437561826 NPI number — OPPORTUNITY VILLAGE ASSOCIATION FOR RETARDED CITIZENS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPPORTUNITY VILLAGE ASSOCIATION FOR RETARDED CITIZENS
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:
1437561826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6050 SOUTH BUFFALO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89113-2154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-259-3707
Provider Business Mailing Address Fax Number:
702-258-0652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6300 WEST OAKLEY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-262-1572
Provider Business Practice Location Address Fax Number:
702-259-3734
Provider Enumeration Date:
05/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
MATHEW
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
702-259-3707

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9005036957 . This is a "API" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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