Provider Demographics
NPI:1740738533
Name:NEVADA TREATMENT CENTER INC.
Entity Type:Organization
Organization Name:NEVADA TREATMENT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FESTUS
Authorized Official - Middle Name:
Authorized Official - Last Name:EBONKA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-515-9680
Mailing Address - Street 1:1721 E CHARLESTON BLVD
Mailing Address - Street 2:1721
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1902
Mailing Address - Country:US
Mailing Address - Phone:702-515-9680
Mailing Address - Fax:
Practice Address - Street 1:1721 EAST CHARLESTON BLVD
Practice Address - Street 2:1721
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104
Practice Address - Country:US
Practice Address - Phone:702-515-9680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA CARE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN000902261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care