Basic Information
| Provider Information | |||||||||
| NPI: | 1093085425 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOUNTIFUL FAMILY SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1485 W WARM SPRINGS RD STE 107 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890147632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025470201 | ||||||||
| FaxNumber: | 7029447846 | ||||||||
| Practice Location | |||||||||
| Address1: | 1485 W WARM SPRINGS RD STE 107 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890147632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025470201 | ||||||||
| FaxNumber: | 7029447846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2012 | ||||||||
| LastUpdateDate: | 06/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | ULIBARRI | ||||||||
| AuthorizedOfficialFirstName: | KARLENE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7029279271 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | NV20111245989 | NV | Y | Agencies | Community/Behavioral Health |
No ID Information.