Provider Demographics
NPI:1285024968
Name:FORT PEACE
Entity Type:Organization
Organization Name:FORT PEACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRINK
Authorized Official - Suffix:III
Authorized Official - Credentials:BISHOP
Authorized Official - Phone:702-546-9431
Mailing Address - Street 1:7121 W CRAIG RD STE 113
Mailing Address - Street 2:UNIT 148
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6023
Mailing Address - Country:US
Mailing Address - Phone:702-546-9431
Mailing Address - Fax:
Practice Address - Street 1:7121 W CRAIG RD STE 113
Practice Address - Street 2:UNIT 148
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6023
Practice Address - Country:US
Practice Address - Phone:702-546-9431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSE OF SHARON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health