Provider Demographics
NPI:1871886507
Name:M.O.M.S COMMUNITY DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:M.O.M.S COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-639-4400
Mailing Address - Street 1:3620 N RANCHO DR STE 111
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3154
Mailing Address - Country:US
Mailing Address - Phone:702-639-4400
Mailing Address - Fax:702-639-4403
Practice Address - Street 1:3620 N RANCHO DR STE 111
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3154
Practice Address - Country:US
Practice Address - Phone:702-639-4400
Practice Address - Fax:702-639-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty