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General NPI Number Information
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NPI Number | 1104161207
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Entity Type | Organization
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Legal Business Name | NEW VISIONS BEHAVIORAL HEALTH ACADEMY LLC
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Dates
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Enumeration Date | 11/30/2012
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 3550 W. CHEYENNE AVE. STE. 110
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-8252
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Country | US
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Telephone | 702-570-5421
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Fax | 702-570-5062
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Provider Business Mailing Address
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Address Line | 3550 W. CHEYENNE AVE. STE. 110
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-8252
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Country | US
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Telephone | 702-570-5421
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Fax | 702-570-5062
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Authorized Official
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Title or Position | OWNER
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Name | ANDRE LORENZO BAILEY
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Credential |
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Telephone | 702-506-3921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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