Healthcare Provider Details

I. General information

NPI: 1164811121
Provider Name (Legal Business Name): AAC LAS VEGAS OUTPATIENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 S EASTERN AVE
LAS VEGAS NV
89169-3314
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 702-545-6444
  • Fax: 615-457-8094
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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