MEDICARE: CENTERS FOR NEUROBEHAVIORAL EXCELLENCE

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	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1578124939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERS FOR NEUROBEHAVIORAL EXCELLENCE

Provider Business Mailing Address
First Line	:	2209 BARCHETTA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6028
Country	:	US
Telephone Number	:	702-787-7839
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 BARCHETTA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6028
Country	:	US
Telephone Number	:	702-787-7839
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JULIE LYNN PETERSON
Credential	:	M.A. CCC-SLP, M.A.ED
Telephone Number	:	702-787-7839

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	06/26/2019

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