MEDICARE: F.A.I.T.H. BEHAVIORAL SERVICES AND WELLNESS CENTER

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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1598312894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	F.A.I.T.H. BEHAVIORAL SERVICES AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	4175 N RANCHO DR STE 160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3472
Country	:	US
Telephone Number	:	702-331-0951
Fax Number	:

Provider Business Practice Location Address
First Line	:	4175 N RANCHO DR STE 160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3472
Country	:	US
Telephone Number	:	702-331-0951
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IESHA CHANEY
Credential	:
Telephone Number	:	702-331-0951

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	08/21/2019

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