Provider Demographics
NPI:1649463761
Name:PACIFIC ALLIANCE
Entity type:Organization
Organization Name:PACIFIC ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-997-9600
Mailing Address - Street 1:2654 W HORIZON RIDGE PKWY # B5109
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2803
Mailing Address - Country:US
Mailing Address - Phone:702-997-9600
Mailing Address - Fax:
Practice Address - Street 1:2654 W HORIZON RIDGE PKWY # B5109
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2803
Practice Address - Country:US
Practice Address - Phone:702-997-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care