Provider Demographics
NPI:1336443951
Name:EASTER SEALS SOUTHERN NEVADA
Entity Type:Organization
Organization Name:EASTER SEALS SOUTHERN NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MALCOLM
Authorized Official - Last Name:PATCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS
Authorized Official - Phone:702-870-7050
Mailing Address - Street 1:6200 W OAKEY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1103
Mailing Address - Country:US
Mailing Address - Phone:702-870-7050
Mailing Address - Fax:
Practice Address - Street 1:6200 W OAKEY BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1103
Practice Address - Country:US
Practice Address - Phone:702-870-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty