Provider Demographics
NPI:1922548460
Name:SPIRIT OF DAVID BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:SPIRIT OF DAVID BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAVELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-957-8550
Mailing Address - Street 1:2113 SUN AVE APT B
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-8176
Mailing Address - Country:US
Mailing Address - Phone:702-957-8550
Mailing Address - Fax:
Practice Address - Street 1:2113 SUN AVE APT B
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-8176
Practice Address - Country:US
Practice Address - Phone:702-957-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness