Provider Demographics
NPI:1215501416
Name:APPLE GROVE TREATMENT CENTER
Entity type:Organization
Organization Name:APPLE GROVE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:S
Authorized Official - Last Name:KORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-992-0576
Mailing Address - Street 1:3155 E PATRICK LN STE 1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3481
Mailing Address - Country:US
Mailing Address - Phone:702-992-0576
Mailing Address - Fax:702-992-0391
Practice Address - Street 1:3155 E PATRICK LN STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3481
Practice Address - Country:US
Practice Address - Phone:702-992-0576
Practice Address - Fax:702-992-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-13
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency