MEDICARE: ACHIEVEMENT BEHAVIORAL 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	NV20101751431	NV

General Provider Information

NPI Number	:	1750687398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACHIEVEMENT BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	5426 LAKE CHARLES ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2007
Country	:	US
Telephone Number	:	702-287-0948
Fax Number	:	702-664-0674

Provider Business Practice Location Address
First Line	:	5426 LAKE CHARLES ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2007
Country	:	US
Telephone Number	:	702-287-0948
Fax Number	:	702-664-0674

Authorized Official
Title or Position	:	PRESIDENT /CEO
Name	:	JOANN LUJAN
Credential	:	L.C.S.W.
Telephone Number	:	702-287-0948

Provider Enumeration Date	:	01/30/2011
Last Update Date	:	01/30/2011

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