Provider Demographics
NPI:1316354202
Name:NEVADA DIVORCE CENTER
Entity type:Organization
Organization Name:NEVADA DIVORCE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIAFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-850-5109
Mailing Address - Street 1:800 N RAINBOW BLVD
Mailing Address - Street 2:#161
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1189
Mailing Address - Country:US
Mailing Address - Phone:702-800-4632
Mailing Address - Fax:
Practice Address - Street 1:800 N RAINBOW BLVD
Practice Address - Street 2:#161
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1189
Practice Address - Country:US
Practice Address - Phone:702-800-4632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-13
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health