Healthcare Provider Details

I. General information

NPI: 1346742210
Provider Name (Legal Business Name): EMBRACING GREATNESS BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5304 HOLLYRIDGE ST
N LAS VEGAS NV
89081-4000
US

IV. Provider business mailing address

5304 HOLLYRIDGE ST
N LAS VEGAS NV
89081-4000
US

V. Phone/Fax

Practice location:
  • Phone: 909-649-2141
  • Fax:
Mailing address:
  • Phone: 909-649-2141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUSTIN MARSCHKE
Title or Position: OWNER
Credential:
Phone: 909-649-2141