Provider Demographics
NPI:1508241068
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:702-376-2838
Mailing Address - Street 1:165 VITALE AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9208
Mailing Address - Country:US
Mailing Address - Phone:702-376-2838
Mailing Address - Fax:
Practice Address - Street 1:12231 S EASTERN AVE STE 140
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4415
Practice Address - Country:US
Practice Address - Phone:702-376-2838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty