MEDICARE: CATCH 22 LIFE SERVICES 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	E0205822014-5	NV

General Provider Information

NPI Number	:	1053731851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATCH 22 LIFE SERVICES LLC.

Provider Business Mailing Address
First Line	:	244 SERENITY RIDGE CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5913
Country	:	US
Telephone Number	:	702-883-6604
Fax Number	:

Provider Business Practice Location Address
First Line	:	244 SERENITY RIDGE CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5913
Country	:	US
Telephone Number	:	702-883-6604
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JER ROBERSON-STRANGE
Credential	:	MSW, LSW
Telephone Number	:	702-883-6604

Provider Enumeration Date	:	04/18/2014
Last Update Date	:	04/18/2014

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Directions to “CATCH 22 LIFE SERVICES LLC. ” Practice Location

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