Provider Demographics
NPI:1558864439
Name:CHARLESTON RESIDENTIAL SERVICES LLC
Entity Type:Organization
Organization Name:CHARLESTON RESIDENTIAL SERVICES LLC
Other - Org Name:CROSSROADS OF SOUTHERN NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MORSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-332-3228
Mailing Address - Street 1:2121 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2205
Mailing Address - Country:US
Mailing Address - Phone:702-382-7746
Mailing Address - Fax:
Practice Address - Street 1:2121 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2205
Practice Address - Country:US
Practice Address - Phone:702-382-7746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health