Provider Demographics
NPI:1659766137
Name:JUST LIKE FAMILY
Entity Type:Organization
Organization Name:JUST LIKE FAMILY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFORTRA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-489-4503
Mailing Address - Street 1:1118 KRUGER CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-9005
Mailing Address - Country:US
Mailing Address - Phone:702-489-4503
Mailing Address - Fax:
Practice Address - Street 1:1118 KRUGER CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-9005
Practice Address - Country:US
Practice Address - Phone:702-489-4503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141299285305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization