MEDICARE: NEVADA MENTORING AND BEHAVIORAL HEALTH SERVICES 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	NV20141775229	NV

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	:	1588062772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA MENTORING AND BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	1117 COBBLESTONE COVE RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-3072
Country	:	US
Telephone Number	:	702-858-3160
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 COBBLESTONE COVE RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-3072
Country	:	US
Telephone Number	:	702-858-3160
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	VENESA L HINES
Credential	:
Telephone Number	:	702-858-3160

Provider Enumeration Date	:	12/20/2014
Last Update Date	:	12/20/2014

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