Provider Demographics
NPI:1942587548
Name:CONFUZION52
Entity Type:Organization
Organization Name:CONFUZION52
Other - Org Name:TEEN FUZION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMMUNITY HEALTH REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:EILA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-633-9196
Mailing Address - Street 1:PO BOX 336514
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89033-6514
Mailing Address - Country:US
Mailing Address - Phone:702-633-9196
Mailing Address - Fax:
Practice Address - Street 1:531 BLACKBIRD KNOLL CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-1316
Practice Address - Country:US
Practice Address - Phone:702-633-9196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty