MEDICARE: BRISCOTOWN

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	251B00000X	Case Management Agency		NV
2	251S00000X	Community/Behavioral Health Agency		NV

General Provider Information

NPI Number	:	1063875896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRISCOTOWN

Provider Business Mailing Address
First Line	:	7357 JELSON FALLS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-2654
Country	:	US
Telephone Number	:	818-805-6111
Fax Number	:

Provider Business Practice Location Address
First Line	:	7357 JELSON FALLS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-2654
Country	:	US
Telephone Number	:	818-805-6111
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	TRENTON BRISCO
Credential	:
Telephone Number	:	818-805-6111

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	03/30/2016

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Directions to “BRISCOTOWN ” Practice Location

Language	Start Address	Practice Location

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