MEDICARE: VIRTUE RECOVERY LAS VEGAS, 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	261QM0850X	Adult Mental Health Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1013617919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRTUE RECOVERY LAS VEGAS, LLC

Provider Business Mailing Address
First Line	:	5850 CANOGA AVE STE 130
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6505
Country	:	US
Telephone Number	:	818-928-0038
Fax Number	:	818-806-0245

Provider Business Practice Location Address
First Line	:	9230 CORBETT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-2337
Country	:	US
Telephone Number	:	818-928-0038
Fax Number	:	818-806-0245

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MARLA MEZA
Credential	:
Telephone Number	:	818-928-0038

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	06/09/2023

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