Apple Grove Treatment Center

Primary specialty

Respite CareTaxonomy code 385H00000X

Legal business name

APPLE GROVE TREATMENT CENTER

Practice address

3155 E Patrick LN Ste 1
Las Vegas, NV 89120-3481

Phone

(702) 992-0576

Fax

(702) 992-0391

NPI assigned

Oct 22, 2019

Organization subpart

No

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

Authorized official

Name

Mrs. Icia Sandulak

Title

Managing Member

Phone

(702) 576-7942

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Apple Grove Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1571702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1730722778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3155 E PATRICK LN STE 1",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891203481",
            "telephone_number": "702-992-0576",
            "fax_number": "702-992-0391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3155 E PATRICK LN STE 1",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891203481",
            "telephone_number": "702-992-0576",
            "fax_number": "702-992-0391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APPLE GROVE TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-22",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "SANDULAK",
        "authorized_official_first_name": "ICIA",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "702-576-7942",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APPLE GROVE",
            "identifier": "571237806",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Other",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3155 E Patrick Ln Ste 1",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891203481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Apple Grove",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Apple Grove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Las Vegas, NV
• Respite Care in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.