Healthcare Provider Details

I. General information

NPI: 1275879199
Provider Name (Legal Business Name): CONCORDE TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 E TWAIN AVE
LAS VEGAS NV
89121-4011
US

IV. Provider business mailing address

500 WILSON PIKE CIR STE 360
BRENTWOOD TN
37027-3266
US

V. Phone/Fax

Practice location:
  • Phone: 702-431-4345
  • Fax: 702-431-4406
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number7470
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number7470
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number7470
License Number StateNV

VIII. Authorized Official

Name: KRISTIN BERG
Title or Position: FACILITY EXECUTIVE DIRECTOR
Credential:
Phone: 702-789-6233