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General NPI Number Information
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NPI Number | 1396011474
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Entity Type | Organization
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Legal Business Name | AAYB HEALTH SERVICES
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 7473 W LAKE MEAD BLVD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89128-0265
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Country | US
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Telephone | 702-562-8199
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Fax |
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Provider Business Mailing Address
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Address Line | 7473 W LAKE MEAD BLVD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89128-0265
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Country | US
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Telephone | 702-562-8199
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Fax |
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Authorized Official
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Title or Position | SECRATARY
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Name | R MIKO RICHARDSON
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Credential |
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Telephone | 702-562-8199
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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 | NV20121179876
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License Number State | NV
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