Provider Demographics
NPI:1881384204
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 1:4225 S EASTERN AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5485
Mailing Address - Country:US
Mailing Address - Phone:725-204-0953
Mailing Address - Fax:
Practice Address - Street 1:4225 S EASTERN AVE STE 8
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5485
Practice Address - Country:US
Practice Address - Phone:725-204-0953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE BEHAVIORAL CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health