Basic Information
| Provider Information | |||||||||
| NPI: | 1184095481 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOJAVE ADULT, CHILD & FAMILY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 E CHARLESTON BLVD STE 230 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891046682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029684015 | ||||||||
| FaxNumber: | 7029685050 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 E CHARLESTON BLVD STE 230 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891046682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029684015 | ||||||||
| FaxNumber: | 7029685050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2015 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | CHAE-BEAN | ||||||||
| AuthorizedOfficialFirstName: | HI | ||||||||
| AuthorizedOfficialMiddleName: | SUK | ||||||||
| AuthorizedOfficialTitleorPosition: | CASE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7029684015 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNIVERSITY OF NEVADA SCHOOL OF MEDICINE | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.A.,C.R.C. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | NV | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1366477036 | 05 | NV | MEDICAID |