Provider Demographics
NPI:1639998263
Name:CRISIS CARE AND LIFE ENHANCEMENT CENTER LLC
Entity type:Organization
Organization Name:CRISIS CARE AND LIFE ENHANCEMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTWONE
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:725-293-1333
Mailing Address - Street 1:800 N RAINBOW BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1190
Mailing Address - Country:US
Mailing Address - Phone:702-966-7340
Mailing Address - Fax:
Practice Address - Street 1:800 N RAINBOW BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1190
Practice Address - Country:US
Practice Address - Phone:702-966-7340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty