Provider Demographics
NPI:1902003155
Name:BUILDING INTELLIGENT GENERATIONS III
Entity Type:Organization
Organization Name:BUILDING INTELLIGENT GENERATIONS III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHSNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-883-9591
Mailing Address - Street 1:4080 PARADISE RD
Mailing Address - Street 2:15-297
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-4834
Mailing Address - Country:US
Mailing Address - Phone:702-685-7944
Mailing Address - Fax:702-685-8309
Practice Address - Street 1:4080 PARADISE RD
Practice Address - Street 2:15-297
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-4834
Practice Address - Country:US
Practice Address - Phone:702-883-9591
Practice Address - Fax:702-685-8309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510961Medicaid