Provider Demographics
NPI:1851945505
Name:FATHER FLANAGAN'S BOYS' HOME
Entity Type:Organization
Organization Name:FATHER FLANAGAN'S BOYS' HOME
Other - Org Name:BOYS TOWN NEVADA INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:531-355-8104
Mailing Address - Street 1:6460 MEDICAL CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2406
Mailing Address - Country:US
Mailing Address - Phone:702-888-1340
Mailing Address - Fax:
Practice Address - Street 1:821 N MOJAVE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2407
Practice Address - Country:US
Practice Address - Phone:702-642-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty