Healthcare Provider Details

I. General information

NPI: 1801227293
Provider Name (Legal Business Name): ASSURANT BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S RAINBOW BLVD STE 130 SUITE 130
LAS VEGAS NV
89146-2900
US

IV. Provider business mailing address

2001 S RAINBOW BLVD STE 130 SUITE 130
LAS VEGAS NV
89146-2900
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-4673
  • Fax: 702-453-2673
Mailing address:
  • Phone: 702-453-4673
  • Fax: 702-453-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. PRISCILLA V OTOO-DAVIS
Title or Position: DIRECTOR
Credential:
Phone: 702-453-4673