MEDICARE: SAVING GRACE MENTAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	343900000X	Non-emergency Medical Transport (VAN)
2	101YM0800X	Mental Health Counselor
3	251B00000X	Case Management Agency
4	251S00000X	Community/Behavioral Health Agency
5	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1548927932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAVING GRACE MENTAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	3970 PALOS VERDES ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6999
Country	:	US
Telephone Number	:	909-660-3222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3970 PALOS VERDES ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6999
Country	:	US
Telephone Number	:	909-660-3222
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	MS. KIMBERLY D ALEXANDER
Credential	:	RN
Telephone Number	:	909-660-2322

Provider Enumeration Date	:	11/20/2021
Last Update Date	:	11/20/2021

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