MEDICARE: NEVADA COMMUNITY HEALTH SERVICES, 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	251B00000X	Case Management Agency	NV20151733324	NV

General Provider Information

NPI Number	:	1407211006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA COMMUNITY HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	7245 COTTONSPARROW ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-8220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3708 FOX GLEN PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-5234
Country	:	US
Telephone Number	:	702-601-5181
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MONICA JOHNSON
Credential	:
Telephone Number	:	702-601-5181

Provider Enumeration Date	:	12/23/2015
Last Update Date	:	12/23/2015

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