Provider Demographics
NPI:1609165695
Name:MAKING A DIFFERENCE IN NEVADA LLC
Entity Type:Organization
Organization Name:MAKING A DIFFERENCE IN NEVADA LLC
Other - Org Name:M.A.D.I.N
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CARMEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-533-6008
Mailing Address - Street 1:5033 BLUE ROSE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-2676
Mailing Address - Country:US
Mailing Address - Phone:702-533-6008
Mailing Address - Fax:702-685-1289
Practice Address - Street 1:5033 BLUE ROSE ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-2676
Practice Address - Country:US
Practice Address - Phone:702-533-6008
Practice Address - Fax:702-685-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health