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General NPI Number Information
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NPI Number | 1700203239
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Entity Type | Organization
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Legal Business Name | MOTIVATED MIRACLES BEHAVORIAL HEALTH SERVICES
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Dates
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Enumeration Date | 03/21/2014
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 8892 OCEANSIDE SLOPES AVE
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City | LAS VEGAS
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State | NV
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Zip | 89178-7524
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Country | US
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Telephone | 702-204-8332
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Fax |
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Provider Business Mailing Address
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Address Line | 8892 OCEANSIDE SLOPES AVE
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City | LAS VEGAS
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State | NV
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Zip | 89178-7524
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Country | US
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Telephone | 702-204-8332
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEANDREA STANSBERRY
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Credential |
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Telephone | 702-204-8332
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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 | NV20131681054
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License Number State | NV
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