Provider Demographics
NPI:1619351244
Name:COMMUNITY ALLIANCE NETWORK AND DEVELOPMENT OUTREACH
Entity Type:Organization
Organization Name:COMMUNITY ALLIANCE NETWORK AND DEVELOPMENT OUTREACH
Other - Org Name:WHAM INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:COMMUNITY HEALTH WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONCEPCION
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNUNZIO
Authorized Official - Suffix:
Authorized Official - Credentials:ACREDITED
Authorized Official - Phone:702-675-6403
Mailing Address - Street 1:2770 S MARYLAND PKWY STE 211
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1565
Mailing Address - Country:US
Mailing Address - Phone:702-675-3400
Mailing Address - Fax:
Practice Address - Street 1:2770 S MARYLAND PKWY STE 211
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1565
Practice Address - Country:US
Practice Address - Phone:702-675-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV200137-320103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty