Provider Demographics
NPI:1053814517
Name:HUNTRIDGE FAMILY CLINIC FOUNDATION DBA PRISM HEALTH SERVICES FOUNDATIO
Entity Type:Organization
Organization Name:HUNTRIDGE FAMILY CLINIC FOUNDATION DBA PRISM HEALTH SERVICES FOUNDATIO
Other - Org Name:FULL SPECTRUM HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-430-9620
Mailing Address - Street 1:8550 W CHARLESTON BLVD #102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117
Mailing Address - Country:US
Mailing Address - Phone:702-430-9620
Mailing Address - Fax:702-430-9630
Practice Address - Street 1:7670 WEST SAHARA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-430-9620
Practice Address - Fax:702-430-9630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUNTRIDGE FAMILY CLINIC FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-12
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty