Provider Demographics
NPI:1275304826
Name:SPANISH MUSTANG, LLC
Entity Type:Organization
Organization Name:SPANISH MUSTANG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-278-1774
Mailing Address - Street 1:35 E HORIZON RIDGE PKWY # 110428
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-7905
Mailing Address - Country:US
Mailing Address - Phone:725-278-1774
Mailing Address - Fax:
Practice Address - Street 1:35 E HORIZON RIDGE PKWY # 110428
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-7905
Practice Address - Country:US
Practice Address - Phone:725-278-1774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No177F00000XOther Service ProvidersLodging