MEDICARE: BROOKS BEHAVIORAL HEALTH CENTER 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	:	1548548597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKS BEHAVIORAL HEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	3550 W CHEYENNE AVE
Second Line	:	SUITE 130
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8212
Country	:	US
Telephone Number	:	702-882-9002
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 W CHEYENNE AVE
Second Line	:	SUITE 130
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8212
Country	:	US
Telephone Number	:	702-882-9002
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEVIN J A BROOKS
Credential	:
Telephone Number	:	702-882-9002

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	11/14/2014

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