Provider Demographics
NPI:1598204604
Name:LEVADA HOUSE
Entity Type:Organization
Organization Name:LEVADA HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWBER
Authorized Official - Prefix:
Authorized Official - First Name:ARIELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-247-4535
Mailing Address - Street 1:5828 COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3820
Mailing Address - Country:US
Mailing Address - Phone:928-529-8197
Mailing Address - Fax:
Practice Address - Street 1:3365 W CRAIG RD
Practice Address - Street 2:STE # 9
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5112
Practice Address - Country:US
Practice Address - Phone:702-247-4535
Practice Address - Fax:702-247-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20151522395320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness