Healthcare Provider Details

I. General information

NPI: 1801376108
Provider Name (Legal Business Name): MSCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3753 HOWARD HUGHES PKWY STE 234
LAS VEGAS NV
89169-0938
US

IV. Provider business mailing address

16 DELIGHTED AVE
NORTH LAS VEGAS NV
89031-1393
US

V. Phone/Fax

Practice location:
  • Phone: 702-417-1366
  • Fax:
Mailing address:
  • Phone: 404-437-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCP0283
License Number StateNV

VIII. Authorized Official

Name: RASHEDA LINNEA ANDERSON
Title or Position: CEO
Credential:
Phone: 404-437-0596