Provider Demographics
NPI:1699015800
Name:INDIAN SPRINGS COMMUNITY SERVICES
Entity Type:Organization
Organization Name:INDIAN SPRINGS COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-994-1821
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:INDIAN SPRINGS
Mailing Address - State:NV
Mailing Address - Zip Code:89018-0700
Mailing Address - Country:US
Mailing Address - Phone:702-379-7298
Mailing Address - Fax:
Practice Address - Street 1:231 S 3RD ST
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-5914
Practice Address - Country:US
Practice Address - Phone:702-751-2535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20121570862251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health