IndividualActive
Cornell Jefferson
NPI 1396004263 · Mental Illness Community Based Residential Treatment Facility · Las Vegas, NV
Provider details
- NPI number
- 1396004263
- Entity type
- Individual
- Primary specialty
- Mental Illness Community Based Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Male
- Sole proprietor
- Yes
- License
- 320800000X (NV)
Specialties & taxonomies
- Mental Illness Community Based Residential Treatment FacilityPrimary320800000XLicense 320800000X (NV)
Residential Treatment Facilities
Profile Score
Detailed profile(79/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
14 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4915 E Russell Rd Apt 125
Las Vegas, NV 89120-2387
Phone: (702) 788-0091
Street-level locationGet directions
Mailing address
4915 E Russell Rd Apt 125
Las Vegas, NV 89120-2387
Registry dates
- Enumerated
- 2012-05-11
- Last updated
- 2012-05-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.