Healthcare Provider Details

I. General information

NPI: 1588902845
Provider Name (Legal Business Name): BEHAVIORAL SERVICES OF SOUTHERN NEVADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 E TROPICANA AVE STE G
LAS VEGAS NV
89121-7305
US

IV. Provider business mailing address

2799 E TROPICANA AVE STE G
LAS VEGAS NV
89121-7305
US

V. Phone/Fax

Practice location:
  • Phone: 702-327-0532
  • Fax:
Mailing address:
  • Phone: 702-327-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number5510-C
License Number StateNV

VIII. Authorized Official

Name: HEATHER A LILES
Title or Position: OPERATING MANAGER
Credential:
Phone: 702-327-0532