Basic Information
| Provider Information | |||||||||
| NPI: | 1609285014 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE GATEWAY CENTER LAS VEGAS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 74 N PECOS RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890747343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027784500 | ||||||||
| FaxNumber: | 7027783500 | ||||||||
| Practice Location | |||||||||
| Address1: | 74 N PECOS RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890747343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027784500 | ||||||||
| FaxNumber: | 7027783500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2014 | ||||||||
| LastUpdateDate: | 08/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | STILL | ||||||||
| AuthorizedOfficialFirstName: | MEREDITH | ||||||||
| AuthorizedOfficialMiddleName: | MILNE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF HUMAN RESOURCES | ||||||||
| AuthorizedOfficialTelephone: | 7024200919 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0700X | NV20141465166 | NV | N | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | 261QD1600X | NV20141465166 | NV | Y | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No ID Information.