Provider Demographics
NPI:1366843930
Name:CENTRE FOR PSYCHOSOCIAL REHABILITATION SERVICES
Entity Type:Organization
Organization Name:CENTRE FOR PSYCHOSOCIAL REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITRIECE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUMBRY
Authorized Official - Suffix:
Authorized Official - Credentials:QMHA
Authorized Official - Phone:702-419-1262
Mailing Address - Street 1:8565 S EASTERN AVE
Mailing Address - Street 2:#150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2808
Mailing Address - Country:US
Mailing Address - Phone:702-419-1262
Mailing Address - Fax:
Practice Address - Street 1:8565 S EASTERN AVE
Practice Address - Street 2:#150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2808
Practice Address - Country:US
Practice Address - Phone:702-419-1262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-14
Last Update Date:2014-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management