Provider Demographics
NPI:1467876292
Name:PRETTYBOY EMPIRE HOMES FOR L.G.B.T.Q. YOUTH
Entity Type:Organization
Organization Name:PRETTYBOY EMPIRE HOMES FOR L.G.B.T.Q. YOUTH
Other - Org Name:GAY AND LESBIAN ADOLESCENT SOCIAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:BESSE
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV
Authorized Official - Phone:917-981-0503
Mailing Address - Street 1:1205 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1506
Mailing Address - Country:US
Mailing Address - Phone:917-981-0503
Mailing Address - Fax:
Practice Address - Street 1:1205 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1506
Practice Address - Country:US
Practice Address - Phone:917-981-0503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========Medicaid