MEDICARE: STEPS FOR CHANGE BEHAVIORAL HEALTHCARE

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		NV

General Provider Information

NPI Number	:	1568898161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPS FOR CHANGE BEHAVIORAL HEALTHCARE

Provider Business Mailing Address
First Line	:	PO BOX 157
Second Line	:
City	:	RAMSEUR
State	:	NC
Zip	:	27316-0157
Country	:	US
Telephone Number	:	336-302-0801
Fax Number	:	336-824-1737

Provider Business Practice Location Address
First Line	:	528 S CASINO CENTER BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6526
Country	:	US
Telephone Number	:	336-302-0801
Fax Number	:	336-824-1737

Authorized Official
Title or Position	:	CEO
Name	:	KIMESHA K SPINKS
Credential	:
Telephone Number	:	336-302-0801

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/16/2013

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