Provider Demographics
NPI:1497189666
Name:OUR LITTLE WORLD TREATMENT CENTER
Entity Type:Organization
Organization Name:OUR LITTLE WORLD TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SALVADORA
Authorized Official - Middle Name:
Authorized Official - Last Name:GODOROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-742-3093
Mailing Address - Street 1:12231 S EASTERN AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4415
Mailing Address - Country:US
Mailing Address - Phone:702-742-3093
Mailing Address - Fax:
Practice Address - Street 1:12231 S EASTERN AVE STE 140
Practice Address - Street 2:3RD FLOOR
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4415
Practice Address - Country:US
Practice Address - Phone:702-742-3093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-23
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131474316101YM0800X
174400000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty