Provider Demographics
NPI:1073750626
Name:ASSERTIVE LIVING
Entity Type:Organization
Organization Name:ASSERTIVE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:702-302-1105
Mailing Address - Street 1:1350 E FLAMINGO RD
Mailing Address - Street 2:BOX 577
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5263
Mailing Address - Country:US
Mailing Address - Phone:702-202-2902
Mailing Address - Fax:702-202-6551
Practice Address - Street 1:3430 E FLAMINGO RD
Practice Address - Street 2:STE 220
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5003
Practice Address - Country:US
Practice Address - Phone:702-202-2902
Practice Address - Fax:702-202-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-18
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005055395Medicaid