Provider Demographics
NPI: | 1598202244 |
---|---|
Name: | INFINITE POSSIBILITIES BEHAVIORAL HEALTHCARE LLC |
Entity Type: | Organization |
Organization Name: | INFINITE POSSIBILITIES BEHAVIORAL HEALTHCARE LLC |
Other - Org Name: | INFINITE POSSIBILITIES BEHAVIORAL HEALTHCARE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANAGING MEMBERS |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KAIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GILBERT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 951-376-0177 |
Mailing Address - Street 1: | 650 S TOWN CENTER DR |
Mailing Address - Street 2: | #2079 |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89144-4419 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-426-9478 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 650 S TOWN CENTER DR |
Practice Address - Street 2: | #2079 |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89144-4419 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-426-9478 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-01-19 |
Last Update Date: | 2017-01-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |