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NPI Code Detail

MEDICARE: GENESIS BEHAVIORAL LLC

MEDICARE: GENESIS BEHAVIORAL 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1760060164
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENESIS BEHAVIORAL LLC
Provider Business Mailing Address
First Line : 5604 HARMONY AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2625
Country : US
Telephone Number : 702-981-4012
Fax Number :
Provider Business Practice Location Address
First Line : 5604 HARMONY AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2625
Country : US
Telephone Number : 702-981-4012
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : YUSLEISY COLLAZO
Credential :
Telephone Number : 702-981-4012
Provider Enumeration Date : 03/30/2021
Last Update Date : 03/30/2021

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Directions to “GENESIS BEHAVIORAL LLC ” Practice Location

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