Provider Demographics
NPI:1922710474
Name:PROMISE LAND ENTERPRISE LLC
Entity Type:Organization
Organization Name:PROMISE LAND ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZEBRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-977-7971
Mailing Address - Street 1:5639 OAK BEND DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1228
Mailing Address - Country:US
Mailing Address - Phone:559-977-7971
Mailing Address - Fax:
Practice Address - Street 1:3800 BELLEAU ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-4422
Practice Address - Country:US
Practice Address - Phone:559-977-7971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health