Provider Demographics
NPI:1457752834
Name:MCDONNELL STEP UP I
Entity Type:Organization
Organization Name:MCDONNELL STEP UP I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:702-241-5472
Mailing Address - Street 1:1072 W BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2218
Mailing Address - Country:US
Mailing Address - Phone:702-241-5472
Mailing Address - Fax:702-410-8016
Practice Address - Street 1:1072 W BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2218
Practice Address - Country:US
Practice Address - Phone:702-241-5472
Practice Address - Fax:702-410-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health