MEDICARE: GIFTED FAMILY SERVICES, 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

General Provider Information

NPI Number	:	1336478510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFTED FAMILY SERVICES, LLC.

Provider Business Mailing Address
First Line	:	825 HOLLOWBLUFF AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1440
Country	:	US
Telephone Number	:	702-591-2664
Fax Number	:	702-586-9656

Provider Business Practice Location Address
First Line	:	825 HOLLOWBLUFF AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1440
Country	:	US
Telephone Number	:	702-591-2664
Fax Number	:	702-586-9656

Authorized Official
Title or Position	:	FOUNDER
Name	:	TRACY HARRIFORD
Credential	:
Telephone Number	:	702-591-2664

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	12/16/2009

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