Provider Demographics
NPI:1396188231
Name:FOR A SUCCESSFUL TOMORROW (F.A.S.T) BEHAVIOR TREATMENT AGENCY LLC
Entity Type:Organization
Organization Name:FOR A SUCCESSFUL TOMORROW (F.A.S.T) BEHAVIOR TREATMENT AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FITZROY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-703-3311
Mailing Address - Street 1:213 N LAMB BLVD
Mailing Address - Street 2:UNIT F
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-0510
Mailing Address - Country:US
Mailing Address - Phone:510-703-3311
Mailing Address - Fax:
Practice Address - Street 1:213 N LAMB BLVD
Practice Address - Street 2:UNIT F
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-0510
Practice Address - Country:US
Practice Address - Phone:510-703-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131207488251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health