MEDICARE: NEW START AT SECOND CHANCE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		NV

General Provider Information

NPI Number	:	1023431327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW START AT SECOND CHANCE LLC

Provider Business Mailing Address
First Line	:	1201 JEFFERSON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2833
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 JEFFERSON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2833
Country	:	US
Telephone Number	:	702-809-5910
Fax Number	:	702-809-5910

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CLIFFORD OSLEY
Credential	:
Telephone Number	:	702-528-3240

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/23/2014

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Directions to “NEW START AT SECOND CHANCE LLC ” Practice Location

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