Provider Demographics
NPI:1396339339
Name:CARE BEHAVIORAL CLINIC LLC
Entity type:Organization
Organization Name:CARE BEHAVIORAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROLLY
Authorized Official - Middle Name:TAGUINOD
Authorized Official - Last Name:QUILANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-242-8703
Mailing Address - Street 1:5346 TIPPER AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-6966
Mailing Address - Country:US
Mailing Address - Phone:858-242-8703
Mailing Address - Fax:
Practice Address - Street 1:5346 TIPPER AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6966
Practice Address - Country:US
Practice Address - Phone:858-242-8703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty