MEDICARE: NEVADA TREATMENT CENTER

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	324500000X	Substance Abuse Rehabilitation Facility	RCE004-457	NV
2	261QM2800X	Methadone Clinic	2567NTC-13	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053491977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA TREATMENT CENTER

Provider Business Mailing Address
First Line	:	1721 EAST CHARLESTON
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104
Country	:	US
Telephone Number	:	702-382-4226
Fax Number	:	702-382-4031

Provider Business Practice Location Address
First Line	:	1721 EAST CHARLESTON
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104
Country	:	US
Telephone Number	:	702-382-4226
Fax Number	:	702-382-4031

Authorized Official
Title or Position	:	CEO
Name	:	JULIE PAYNE
Credential	:
Telephone Number	:	702-382-4226

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	04/17/2009

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