Provider Demographics
NPI:1366933905
Name:NEVADA CANCER CHILDHOOD FOUNDATION
Entity type:Organization
Organization Name:NEVADA CANCER CHILDHOOD FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-735-8434
Mailing Address - Street 1:3711 E SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-6212
Mailing Address - Country:US
Mailing Address - Phone:702-735-8434
Mailing Address - Fax:702-735-8431
Practice Address - Street 1:3711 E SUNSET RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-6212
Practice Address - Country:US
Practice Address - Phone:702-735-8434
Practice Address - Fax:702-735-8431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable