Provider Demographics
NPI:1205079118
Name:FAMILY IMPACT OF NEVADA
Entity type:Organization
Organization Name:FAMILY IMPACT OF NEVADA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEA
Authorized Official - Middle Name:ANTASHA
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-883-9750
Mailing Address - Street 1:2513 BRAVE HEART AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0685
Mailing Address - Country:US
Mailing Address - Phone:702-883-9750
Mailing Address - Fax:
Practice Address - Street 1:2513 BRAVE HEART AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0685
Practice Address - Country:US
Practice Address - Phone:702-883-9750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health