MEDICARE: DISCOVERY ABA NV 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	251S00000X	Community/Behavioral Health Agency

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	:	1285384131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOVERY ABA NV LLC

Provider Business Mailing Address
First Line	:	8126 CRUSHED VELVET PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-3794
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8126 CRUSHED VELVET PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-3794
Country	:	US
Telephone Number	:	718-736-5689
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MR. MARK ELIAS
Credential	:
Telephone Number	:	718-736-5689

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/24/2022

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