Provider Demographics
NPI:1780823930
Name:NEW LEVELS COMMUNITY DEVELOPMENT
Entity Type:Organization
Organization Name:NEW LEVELS COMMUNITY DEVELOPMENT
Other - Org Name:NEW LEVELS INDEPENDENCE PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-510-2642
Mailing Address - Street 1:PO BOX 20074
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89112-2074
Mailing Address - Country:US
Mailing Address - Phone:702-510-2642
Mailing Address - Fax:
Practice Address - Street 1:3880 LEISURE LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2337
Practice Address - Country:US
Practice Address - Phone:702-510-2642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC301272003251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health