Healthcare Provider Details

I. General information

NPI: 1518481530
Provider Name (Legal Business Name): GODSPEED BEHAVIORAL HEALTH L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 FUSILIER DR
N LAS VEGAS NV
89032
US

IV. Provider business mailing address

3805 FUSELIER DR
N LAS VEGAS NV
89032-3003
US

V. Phone/Fax

Practice location:
  • Phone: 503-888-0810
  • Fax:
Mailing address:
  • Phone: 503-888-0810
  • 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: RICHMOND ASAMOAH
Title or Position: DIRECTOR
Credential:
Phone: 503-888-0810