Super Youth of Nevada

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

Legal business name

SUPER YOUTH OF NEVADA

Practice address

867 Worrell Ave
Las Vegas, NV 89123-3183

Phone

(702) 748-1508

NPI assigned

Jan 27, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Demetrius Jemil Hunter

Title

Manager

Phone

(702) 748-1508

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334102400000",
    "number": "1174895890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "867 WORRELL AVE.",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891233183",
            "telephone_number": "702-748-1508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "867 WORRELL AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891233183",
            "telephone_number": "702-748-1508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER YOUTH OF NEVADA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-27",
        "last_updated": "2012-04-11",
        "status": "A",
        "authorized_official_last_name": "HUNTER",
        "authorized_official_first_name": "DEMETRIUS",
        "authorized_official_middle_name": "JEMIL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-748-1508",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Rehabilitation Practitioner",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sunstar Optical, Inc.
• Supa
• Super Care, LLC
• Super Life Codes Foundation
• Super Sell Enterprises
• Superior Connections
• Superior Connections Services LLC
• Superior Medical Group LLC
• Supervista North America
• Salvatore Suppa

• Rehabilitation Practitioner in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Rehabilitation Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.