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NPI Code Detail

MEDICARE: T3SL LLC

MEDICARE: T3SL 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
1251S00000XCommunity/Behavioral Health AgencyNV20121040148NV

General Provider Information

NPI Number : 1740552264
Entity Type Code : Organization
Provider Name (Legal Business Name) : T3SL LLC
Provider Business Mailing Address
First Line : 7473 W LAKE MEAD BLVD
Second Line : STE 100
City : LAS VEGAS
State : NV
Zip : 89128-0265
Country : US
Telephone Number : 702-816-3658
Fax Number : 702-816-4337
Provider Business Practice Location Address
First Line : 2020 PINTO LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4019
Country : US
Telephone Number : 702-816-3658
Fax Number : 702-816-4337
Authorized Official
Title or Position : CEO
Name : MS. TOSHIA D SHAW
Credential : MBA
Telephone Number : 702-816-3658
Provider Enumeration Date : 01/30/2012
Last Update Date : 03/12/2014

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