Provider Demographics
NPI:1053792879
Name:BLUECOVE HOMES LLC
Entity type:Organization
Organization Name:BLUECOVE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:702-834-4307
Mailing Address - Street 1:9535 SCOTTVILLE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4621
Mailing Address - Country:US
Mailing Address - Phone:702-834-4307
Mailing Address - Fax:702-485-4437
Practice Address - Street 1:9535 SCOTTVILLE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4621
Practice Address - Country:US
Practice Address - Phone:702-834-4307
Practice Address - Fax:702-485-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20140769237-41251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health