Provider Demographics
NPI:1093178832
Name:HEIDI SUE UNGER
Entity Type:Organization
Organization Name:HEIDI SUE UNGER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:UNGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-395-1519
Mailing Address - Street 1:14050 KYLE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-1338
Mailing Address - Country:US
Mailing Address - Phone:702-395-1519
Mailing Address - Fax:702-395-2850
Practice Address - Street 1:14050 KYLE CANYON RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-1338
Practice Address - Country:US
Practice Address - Phone:702-395-1519
Practice Address - Fax:702-395-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care