1538499876 NPI number — HOME OF POSSIBILITIES, LLC

Table of content: (NPI 1538499876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538499876 NPI number — HOME OF POSSIBILITIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME OF POSSIBILITIES, LLC
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:
1538499876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 EAST SUNSET ROAD
Provider Second Line Business Mailing Address:
SUITE #40
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-570-5100
Provider Business Mailing Address Fax Number:
702-570-5104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 EAST SUNSET ROAD
Provider Second Line Business Practice Location Address:
SUITE #40
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-570-5100
Provider Business Practice Location Address Fax Number:
702-570-5104
Provider Enumeration Date:
01/08/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BIENIEMY
Authorized Official First Name:
CORY
Authorized Official Middle Name:
RON
Authorized Official Title or Position:
C.E.O./OWNER
Authorized Official Telephone Number:
702-570-5100

Provider Taxonomy Codes

  • Taxonomy code: 225400000X , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , with the licence number: 251S00000X , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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