Provider Demographics
NPI:1831515212
Name:REHAB ALCOHOL DRUG DETOX, INC.
Entity type:Organization
Organization Name:REHAB ALCOHOL DRUG DETOX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:702-228-8520
Mailing Address - Street 1:9811 W CHARLESTON BLVD # 2626
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7528
Mailing Address - Country:US
Mailing Address - Phone:702-228-8520
Mailing Address - Fax:702-448-7205
Practice Address - Street 1:2975 S RAINBOW BLVD STE E
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6242
Practice Address - Country:US
Practice Address - Phone:702-228-8520
Practice Address - Fax:702-448-7205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility