SUPER YOUTH OF NEVADA NPI 1174895890

NPI Information

  • NPI: 1174895890
  • Provider Name: SUPER YOUTH OF NEVADA
  • Classification: Rehabilitation Practitioner - 225400000X
  • Entity Type: Organization
  • Address: 867 WORRELL AVE
    LAS VEGAS, NV
    ZIP 89123
  • Phone: (702) 748-1508

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NPI Details

SUPER YOUTH OF NEVADA is a rehabilitation practitioner in Las Vegas, NV. The provider is a health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. SUPER YOUTH OF NEVADA NPI is 1174895890. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

867 WORRELL AVE
LAS VEGAS, NV
ZIP 89123-183
Phone: (702) 748-1508

The provider's authorized official is Demetrius Jemil Hunter .
The authorized official title is Manager and has the following contact phone number (702) 748-1508.

The enumeration date for this NPI number is 1/27/2012 and was last updated on 4/11/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1225400000XRehabilitation PractitionerNEVADAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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