MEDICARE: LIFTING OTHERS BEHAVIOR HEALTH 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	:	1588169189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFTING OTHERS BEHAVIOR HEALTH LLC

Provider Business Mailing Address
First Line	:	3455 W CRAIG RD STE C
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5119
Country	:	US
Telephone Number	:	702-640-0994
Fax Number	:

Provider Business Practice Location Address
First Line	:	642 ANA RAQUEL AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-7828
Country	:	US
Telephone Number	:	702-497-3409
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHATEAA PERRY
Credential	:
Telephone Number	:	702-497-3409

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	08/24/2023

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