Provider Demographics
NPI:1649711383
Name:BREEDLOVE, ADELE HOLSTON
Entity type:Individual
Prefix:
First Name:ADELE
Middle Name:HOLSTON
Last Name:BREEDLOVE
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 1:801 S RANCHO DR
Mailing Address - Street 2:SUITE E2B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3854
Mailing Address - Country:US
Mailing Address - Phone:702-771-5578
Mailing Address - Fax:702-837-0579
Practice Address - Street 1:801 S RANCHO DR
Practice Address - Street 2:SUITE E2B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3854
Practice Address - Country:US
Practice Address - Phone:702-771-5578
Practice Address - Fax:702-837-0579
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator