Provider Demographics
NPI:1265177091
Name:ITS OK 2B DIFFERENT ORGANIZATION
Entity type:Organization
Organization Name:ITS OK 2B DIFFERENT ORGANIZATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PASTORAL
Authorized Official - Phone:702-472-3791
Mailing Address - Street 1:3172 N RAINBOW BLVD # 5077
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4534
Mailing Address - Country:US
Mailing Address - Phone:702-472-3791
Mailing Address - Fax:
Practice Address - Street 1:7853 SCAMMONS BAY CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7316
Practice Address - Country:US
Practice Address - Phone:702-472-3791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No376K00000XNursing Service Related ProvidersNurse's Aide
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty