Healthcare Provider Details

I. General information

NPI: 1114587813
Provider Name (Legal Business Name): JOY BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 S RAINBOW BLVD STE 304
LAS VEGAS NV
89146-6212
US

IV. Provider business mailing address

3130 S RAINBOW BLVD STE 304
LAS VEGAS NV
89146-6212
US

V. Phone/Fax

Practice location:
  • Phone: 702-202-3378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWARD GAMBOA
Title or Position: CEO
Credential:
Phone: 702-488-4198