Healthcare Provider Details

I. General information

NPI: 1083797484
Provider Name (Legal Business Name): CENTER FOR BEHAVIORAL HEALTH NEVADA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 EAST DESERT ROAD SUITE 116
LAS VEGAS NV
89121
US

IV. Provider business mailing address

PO BOX 897
BOISE ID
83701
US

V. Phone/Fax

Practice location:
  • Phone: 702-796-0660
  • Fax: 702-796-1835
Mailing address:
  • Phone: 702-796-0660
  • Fax: 702-796-1835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number2569NTC-7
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateNV

VIII. Authorized Official

Name: MS. MARY MASSMAN
Title or Position: OWNER
Credential:
Phone: 702-796-0660