Provider Demographics
NPI:1437561826
Name:OPPORTUNITY VILLAGE ASSOCIATION FOR RETARDED CITIZENS
Entity Type:Organization
Organization Name:OPPORTUNITY VILLAGE ASSOCIATION FOR RETARDED CITIZENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-259-3707
Mailing Address - Street 1:6050 SOUTH BUFFALO
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2154
Mailing Address - Country:US
Mailing Address - Phone:702-259-3707
Mailing Address - Fax:702-258-0652
Practice Address - Street 1:6300 WEST OAKLEY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1122
Practice Address - Country:US
Practice Address - Phone:702-262-1572
Practice Address - Fax:702-259-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005036957OtherAPI