MEDICARE: STONEBRIDGE BEHAVIORAL HEALTH 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	NV20171534971	NV

General Provider Information

NPI Number	:	1023590544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONEBRIDGE BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	3311 S RAINBOW BLVD STE 112
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6596
Country	:	US
Telephone Number	:	702-772-4446
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 S RAINBOW BLVD STE 112
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6596
Country	:	US
Telephone Number	:	702-772-4446
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MELISSA J REECE-THOMPSON
Credential	:
Telephone Number	:	702-772-4446

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	03/01/2019

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