Provider Demographics
NPI:1619585999
Name:PERSEVERANCE COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:PERSEVERANCE COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIYONNA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-277-5406
Mailing Address - Street 1:5130 S FORT APACHE RD STE 215-164
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1719
Mailing Address - Country:US
Mailing Address - Phone:702-277-5406
Mailing Address - Fax:
Practice Address - Street 1:222 S RAINBOW BLVD STE 211
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5356
Practice Address - Country:US
Practice Address - Phone:702-277-5406
Practice Address - Fax:702-442-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health