Provider Demographics
NPI:1467944991
Name:AWARE VEGAS
Entity Type:Organization
Organization Name:AWARE VEGAS
Other - Org Name:AWARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHINAZOR
Authorized Official - Middle Name:
Authorized Official - Last Name:EZELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-610-4190
Mailing Address - Street 1:149 TYLER CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-0660
Mailing Address - Country:US
Mailing Address - Phone:702-610-4190
Mailing Address - Fax:
Practice Address - Street 1:2800 W SAHARA AVE STE 6C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4383
Practice Address - Country:US
Practice Address - Phone:702-720-9037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management