MEDICARE: CARDINAL MENTAL HEALTHCARE 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1063140812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL MENTAL HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 34736
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-4736
Country	:	US
Telephone Number	:	702-485-3646
Fax Number	:	702-485-3664

Provider Business Practice Location Address
First Line	:	3909 S MARYLAND PKWY STE 405
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7526
Country	:	US
Telephone Number	:	702-485-3646
Fax Number	:	702-485-3664

Authorized Official
Title or Position	:	OWNER
Name	:	SOLOMON JOSHUA
Credential	:	APRN, DNP
Telephone Number	:	702-485-3646

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	08/10/2022

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