Provider Demographics
NPI:1619253598
Name:HATTIE'S HOUSE
Entity Type:Organization
Organization Name:HATTIE'S HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WACONDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-522-0568
Mailing Address - Street 1:PO BOX 73032
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89170-3032
Mailing Address - Country:US
Mailing Address - Phone:702-522-0568
Mailing Address - Fax:702-522-0568
Practice Address - Street 1:510 COLLEGE DR # 1312
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-1532
Practice Address - Country:US
Practice Address - Phone:702-522-0568
Practice Address - Fax:702-522-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No253J00000XAgenciesFoster Care Agency