Provider Demographics
NPI:1184095481
Name:MOJAVE ADULT, CHILD & FAMILY SERVICES
Entity type:Organization
Organization Name:MOJAVE ADULT, CHILD & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HI
Authorized Official - Middle Name:SUK
Authorized Official - Last Name:CHAE-BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CRC
Authorized Official - Phone:702-968-4015
Mailing Address - Street 1:4000 E CHARLESTON BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6682
Mailing Address - Country:US
Mailing Address - Phone:702-968-4015
Mailing Address - Fax:702-968-5050
Practice Address - Street 1:4000 E CHARLESTON BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6682
Practice Address - Country:US
Practice Address - Phone:702-968-4015
Practice Address - Fax:702-968-5050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NEVADA SCHOOL OF MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1366477036Medicaid
NV1366477036Medicaid