Provider Demographics
NPI:1871865386
Name:DARK KNIGHT OSO INC
Entity Type:Organization
Organization Name:DARK KNIGHT OSO INC
Other - Org Name:DKS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THERON
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-717-6971
Mailing Address - Street 1:2300 W SAHARA AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4352
Mailing Address - Country:US
Mailing Address - Phone:702-754-5255
Mailing Address - Fax:702-750-9652
Practice Address - Street 1:2300 W SAHARA AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4352
Practice Address - Country:US
Practice Address - Phone:702-754-5255
Practice Address - Fax:702-750-9652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20121035663172A00000X, 311ZA0620X
251B00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)