Provider Demographics
NPI:1083164693
Name:PRODUCTIVE MEMBER'S OF SOCIETY COMMUNITY AND FAMILY SERVICES
Entity Type:Organization
Organization Name:PRODUCTIVE MEMBER'S OF SOCIETY COMMUNITY AND FAMILY SERVICES
Other - Org Name:PMOS-CFS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD LIFE ENHANCEMENT CONSULTANT-I
Authorized Official - Prefix:
Authorized Official - First Name:LACOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:702-234-9339
Mailing Address - Street 1:2121 E FLAMINGO RD STE 114
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5123
Mailing Address - Country:US
Mailing Address - Phone:702-234-9339
Mailing Address - Fax:
Practice Address - Street 1:2121 E FLAMINGO RD STE 114
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5123
Practice Address - Country:US
Practice Address - Phone:702-234-9339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health