Basic Information
| Provider Information | |||||||||
| NPI: | 1467858464 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTCARE NEVADA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1711 WHITNEY MESA DR | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890142080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023852090 | ||||||||
| FaxNumber: | 7029242575 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 FRANKIE STREET | ||||||||
| Address2: | |||||||||
| City: | TONOPAH | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023853330 | ||||||||
| FaxNumber: | 7029242575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2014 | ||||||||
| LastUpdateDate: | 02/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | MAGRDICHIAN | ||||||||
| AuthorizedOfficialFirstName: | LEO | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7023852090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.