Healthcare Provider Details

I. General information

NPI: 1689233579
Provider Name (Legal Business Name): IMS BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 E FLAMINGO RD STE D
LAS VEGAS NV
89121-5270
US

IV. Provider business mailing address

2860 E FLAMINGO RD STE D
LAS VEGAS NV
89121-5270
US

V. Phone/Fax

Practice location:
  • Phone: 702-202-0291
  • Fax:
Mailing address:
  • Phone: 702-202-0291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CRISTINE SERRANO
Title or Position: CREDENTIALER
Credential:
Phone: 702-487-7055