Provider Demographics
NPI:1528445277
Name:ISU INC
Entity type:Organization
Organization Name:ISU INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHUKA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUMPHREYS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-459-7500
Mailing Address - Street 1:1745 N. NELLIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-3673
Mailing Address - Country:US
Mailing Address - Phone:702-459-7500
Mailing Address - Fax:702-476-2028
Practice Address - Street 1:1745 N. NELLIS BLVD
Practice Address - Street 2:STE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-3673
Practice Address - Country:US
Practice Address - Phone:702-459-7500
Practice Address - Fax:702-459-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20041671856251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health