Provider Demographics
NPI:1518513142
Name:EVERTON'S PLACE LLC
Entity Type:Organization
Organization Name:EVERTON'S PLACE LLC
Other - Org Name:IMPOSSIBLE MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO/DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-622-2679
Mailing Address - Street 1:10166 SKYE SADDLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-6597
Mailing Address - Country:US
Mailing Address - Phone:702-507-0373
Mailing Address - Fax:
Practice Address - Street 1:1333 N BUFFALO DR UNIT 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3637
Practice Address - Country:US
Practice Address - Phone:702-507-0373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)