Provider Demographics
NPI:1417765348
Name:ODEANE, ELEANOR MORANDARTE
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:MORANDARTE
Last Name:ODEANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11292 ROMAN HELMET ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-6210
Mailing Address - Country:US
Mailing Address - Phone:619-985-8274
Mailing Address - Fax:
Practice Address - Street 1:11292 ROMAN HELMET ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-6210
Practice Address - Country:US
Practice Address - Phone:619-985-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities