Healthcare Provider Details

I. General information

NPI: 1699583450
Provider Name (Legal Business Name): LAS VEGAS CHIPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/27/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 S EASTERN AVE
LAS VEGAS NV
89169-3300
US

IV. Provider business mailing address

201 LAS VEGAS BLVD S
LAS VEGAS NV
89101-5780
US

V. Phone/Fax

Practice location:
  • Phone: 702-560-6584
  • Fax:
Mailing address:
  • Phone: 702-560-6584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALEXANDRIA E. BROWN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-560-6584