Provider Demographics
NPI:1861667032
Name:EMBRAISE INC.
Entity Type:Organization
Organization Name:EMBRAISE INC.
Other - Org Name:EMBRAISE INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:V
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:702-370-7842
Mailing Address - Street 1:6325 SNAP RIDGE ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-3847
Mailing Address - Country:US
Mailing Address - Phone:702-370-7842
Mailing Address - Fax:
Practice Address - Street 1:6325 SNAP RIDGE ST UNIT 101
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-3847
Practice Address - Country:US
Practice Address - Phone:702-370-7842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency