MEDICARE: CHARLENE M PRICE

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	:	1467761239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE M PRICE

Provider Business Mailing Address
First Line	:	1116 MALIBU SANDS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1328
Country	:	US
Telephone Number	:	702-575-5238
Fax Number	:	702-649-6374

Provider Business Practice Location Address
First Line	:	1116 MALIBU SANDS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1328
Country	:	US
Telephone Number	:	702-575-5238
Fax Number	:	702-649-6374

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/28/2010

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Directions to “ CHARLENE M PRICE ” Practice Location

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