MEDICARE: ACTIVE BEHAVIORAL HEALTH, 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	:	1528584349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	2600 S TOWN CENTER DR
Second Line	:	2042
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2064
Country	:	US
Telephone Number	:	702-981-1153
Fax Number	:	702-974-4555

Provider Business Practice Location Address
First Line	:	2600 S TOWN CENTER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2064
Country	:	US
Telephone Number	:	702-981-1153
Fax Number	:	702-981-1153

Authorized Official
Title or Position	:	OWNER
Name	:	MR. VINCENT LLAUGER
Credential	:
Telephone Number	:	702-981-1153

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	06/16/2018

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