Basic Information
| Provider Information | |||||||||
| NPI: | 1699292904 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTCARE NEVADA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 94738 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891934738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023852090 | ||||||||
| FaxNumber: | 7029242575 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 N GREEN VALLEY PKWY STE 117-119 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890140273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025308998 | ||||||||
| FaxNumber: | 7025476786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2017 | ||||||||
| LastUpdateDate: | 08/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | MANGUM | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT DIRECTOR OF BILLING | ||||||||
| AuthorizedOfficialTelephone: | 7023852090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.