MEDICARE: LIMITLESS BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1003366097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIMITLESS BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	2405 PARASAIL POINT AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0968
Country	:	US
Telephone Number	:	702-612-2208
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 PARASAIL POINT AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0968
Country	:	US
Telephone Number	:	702-612-2208
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	ZARANESHIA KIRKSON
Credential	:
Telephone Number	:	702-612-2208

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	10/13/2016

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