Ida'S House

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

IDA'S HOUSE

Practice address

4022 Allyson Rae St
North Las Vegas, NV 89032-0258

Phone

(702) 612-6787

NPI assigned

Dec 24, 2014

Organization subpart

No

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

Authorized official

Name

Connie Glenn

Title

Ceo

Phone

(702) 612-6787

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1419379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419379200000",
    "number": "1831587906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8665 W FLAMINGO RD",
            "address_2": "STE # 131",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891478621",
            "telephone_number": "702-612-6787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4022 ALLYSON RAE ST",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890320258",
            "telephone_number": "702-612-6787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDA'S HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-24",
        "last_updated": "2014-12-24",
        "status": "A",
        "authorized_official_last_name": "GLENN",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "702-612-6787"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• Exclusive Provider Organization in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2014; 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.