Provider Demographics
NPI:1407292428
Name:CACTUS CARE CENTER LLC
Entity Type:Organization
Organization Name:CACTUS CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-527-9775
Mailing Address - Street 1:50 N GIBSON RD STE 170
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6795
Mailing Address - Country:US
Mailing Address - Phone:702-527-9775
Mailing Address - Fax:
Practice Address - Street 1:50 N GIBSON RD STE 170
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6795
Practice Address - Country:US
Practice Address - Phone:702-527-9775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131287617251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health