MEDICARE: TRIBE SIN CITY INC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1245921725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIBE SIN CITY INC

Provider Business Mailing Address
First Line	:	2290 MCDANIEL ST STE 1B
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6330
Country	:	US
Telephone Number	:	702-349-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2290 MCDANIEL ST STE 1B
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6330
Country	:	US
Telephone Number	:	702-349-2800
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS HERNANDEZ
Credential	:
Telephone Number	:	702-349-2800

Provider Enumeration Date	:	05/16/2023
Last Update Date	:	05/16/2023

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Directions to “TRIBE SIN CITY INC ” Practice Location

Language	Start Address	Practice Location

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