Provider Demographics
NPI:1003246612
Name:DARK KNIGHT TRUST
Entity Type:Organization
Organization Name:DARK KNIGHT TRUST
Other - Org Name:DARK KNIGHT OSO INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:THERON
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-754-5701
Mailing Address - Street 1:840 S RANCHO DR
Mailing Address - Street 2:SUITE 4-410
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3837
Mailing Address - Country:US
Mailing Address - Phone:702-754-5700
Mailing Address - Fax:702-982-8762
Practice Address - Street 1:840 S RANCHO DR
Practice Address - Street 2:SUITE 4-410
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3837
Practice Address - Country:US
Practice Address - Phone:702-754-5700
Practice Address - Fax:702-982-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20121035663171M00000X, 251B00000X, 253Z00000X, 311Z00000X, 343900000X, 374U00000X
246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care FacilityGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20121035663OtherSTATE OF NEVADA