1619193224 NPI number — COMPREHENSIVE THERAPY CENTERS, LLC

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 1619193224 NPI number — COMPREHENSIVE THERAPY CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE THERAPY CENTERS, 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:
1619193224
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3602 E SUNSET RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89120-7202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-932-4308
Provider Business Mailing Address Fax Number:
702-837-8930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10561 JEFFREYS ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052-4266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-407-9431
Provider Business Practice Location Address Fax Number:
702-407-9461
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DELGADO
Authorized Official First Name:
ALEJANDRO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-932-4308

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , 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: 100506637 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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