MEDICARE: SOUTHERN NEVADA ACADEMY OF DEVELOPMENT AND BEHAVIORAL HEALTH

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	NV20151439330	NV

General Provider Information

NPI Number	:	1053796946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN NEVADA ACADEMY OF DEVELOPMENT AND BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	5005 LOSEE RD
Second Line	:	UNIT 3046
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-2479
Country	:	US
Telephone Number	:	702-373-7248
Fax Number	:

Provider Business Practice Location Address
First Line	:	5005 LOSEE RD
Second Line	:	UNIT 3046
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-2479
Country	:	US
Telephone Number	:	702-373-7248
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DINISHA MINGO
Credential	:	B.,A., QMHA
Telephone Number	:	702-373-7248

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	07/21/2015

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