MEDICARE: THE LENOX GROUP

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
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1861959082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LENOX GROUP

Provider Business Mailing Address
First Line	:	3970 PALOS VERDES ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6999
Country	:	US
Telephone Number	:	919-525-9312
Fax Number	:

Provider Business Practice Location Address
First Line	:	485 KOLSON CIR APT B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6935
Country	:	US
Telephone Number	:	919-673-0894
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT JOHNSON
Credential	:
Telephone Number	:	702-613-2064

Provider Enumeration Date	:	02/24/2019
Last Update Date	:	10/12/2021

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Directions to “THE LENOX GROUP ” Practice Location

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