Provider Demographics
NPI:1053731851
Name:CATCH 22 LIFE SERVICES LLC.
Entity type:Organization
Organization Name:CATCH 22 LIFE SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON-STRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW
Authorized Official - Phone:702-883-6604
Mailing Address - Street 1:244 SERENITY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5913
Mailing Address - Country:US
Mailing Address - Phone:702-883-6604
Mailing Address - Fax:
Practice Address - Street 1:244 SERENITY RIDGE CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5913
Practice Address - Country:US
Practice Address - Phone:702-883-6604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVE0205822014-5251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health