Healthcare Provider Details

I. General information

NPI: 1912334012
Provider Name (Legal Business Name): BEVERLY FELIX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8216 TIVOLI COVE DR
LAS VEGAS NV
89128-7446
US

IV. Provider business mailing address

8216 TIVOLI COVE DR
LAS VEGAS NV
89128-7446
US

V. Phone/Fax

Practice location:
  • Phone: 702-541-9507
  • Fax: 702-541-9507
Mailing address:
  • Phone: 702-406-8923
  • Fax: 702-541-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberNV20253340340
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: