MEDICARE: BROOKS FAMILY CLINIC

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	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1407368814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKS FAMILY CLINIC

Provider Business Mailing Address
First Line	:	3670 N RANCHO DRIVE
Second Line	:	SUITE 106
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3174
Country	:	US
Telephone Number	:	702-570-5200
Fax Number	:	702-473-5223

Provider Business Practice Location Address
First Line	:	3550 W CHEYENNE AVE
Second Line	:	SUITE 100
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8212
Country	:	US
Telephone Number	:	702-570-5200
Fax Number	:	702-570-5201

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. DEVIN BROOKS
Credential	:
Telephone Number	:	702-910-5773

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	10/26/2017

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