Provider Demographics
NPI:1407368814
Name:BROOKS FAMILY CLINIC
Entity Type:Organization
Organization Name:BROOKS FAMILY CLINIC
Other - Org Name:BROOKS METHADONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-910-5773
Mailing Address - Street 1:3670 N RANCHO DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3174
Mailing Address - Country:US
Mailing Address - Phone:702-570-5200
Mailing Address - Fax:702-473-5223
Practice Address - Street 1:3550 W CHEYENNE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8212
Practice Address - Country:US
Practice Address - Phone:702-570-5200
Practice Address - Fax:702-570-5201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKS FAMILY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone