Provider Demographics
NPI:1902167653
Name:CENTENNIAL FAMILY SERVICES
Entity Type:Organization
Organization Name:CENTENNIAL FAMILY SERVICES
Other - Org Name:CENTENNIAL FAMILY SERVICES LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-258-8023
Mailing Address - Street 1:3560 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8260
Mailing Address - Country:US
Mailing Address - Phone:702-258-8023
Mailing Address - Fax:
Practice Address - Street 1:3560 W CHEYENNE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8260
Practice Address - Country:US
Practice Address - Phone:702-258-8023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty