Provider Demographics
NPI:1548550486
Name:COMMUNITY ALLIANCE NETWORK AND DEVELOPMENTAL OUTREACH
Entity type:Organization
Organization Name:COMMUNITY ALLIANCE NETWORK AND DEVELOPMENTAL OUTREACH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANALO GORRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-675-3400
Mailing Address - Street 1:2770 S. MARYLAND PARKWAY
Mailing Address - Street 2:SUITE NO. 211
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109
Mailing Address - Country:US
Mailing Address - Phone:702-675-3400
Mailing Address - Fax:702-675-3403
Practice Address - Street 1:2770 S. MARYLAND PARKWAY
Practice Address - Street 2:SUITE NO. 211
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109
Practice Address - Country:US
Practice Address - Phone:702-675-3400
Practice Address - Fax:702-675-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty