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NPI Code Detail

MEDICARE: EAGLE QUEST

MEDICARE: EAGLE QUEST
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor
3225400000XRehabilitation Practitioner
4251B00000XCase Management Agency
5253J00000XFoster Care Agency
6251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1033419684
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAGLE QUEST
Provider Business Mailing Address
First Line : 3680 N RANCHO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-3180
Country : US
Telephone Number : 702-646-5437
Fax Number : 702-228-8248
Provider Business Practice Location Address
First Line : 3680 N RANCHO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-3180
Country : US
Telephone Number : 702-646-5437
Fax Number : 702-228-8248
Authorized Official
Title or Position : DIRECTOR
Name : RAY TIPPETTS
Credential :
Telephone Number : 702-376-0612
Provider Enumeration Date : 10/29/2010
Last Update Date : 01/19/2021

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Directions to “EAGLE QUEST ” Practice Location

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