Provider Demographics
NPI:1508103516
Name:STAKS ENTERPRISES LLC.
Entity Type:Organization
Organization Name:STAKS ENTERPRISES LLC.
Other - Org Name:MIRACLE EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:PENELOPE
Authorized Official - Last Name:MOLONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-456-0002
Mailing Address - Street 1:PO BOX 36252
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-6252
Mailing Address - Country:US
Mailing Address - Phone:702-456-0002
Mailing Address - Fax:
Practice Address - Street 1:7500 W LAKE MEAD BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0299
Practice Address - Country:US
Practice Address - Phone:702-456-0002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV309237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty