MEDICARE: VEGAS VALLEY TREATMENT CENTER

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	261QM2800X	Methadone Clinic	4530NTC-0	NV

General Provider Information

NPI Number	:	1063617736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEGAS VALLEY TREATMENT CENTER

Provider Business Mailing Address
First Line	:	1325 S COMMERCE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2530
Country	:	US
Telephone Number	:	702-383-9890
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 S COMMERCE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2530
Country	:	US
Telephone Number	:	702-383-9890
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEVEN BENJAMIN ZEITLIN
Credential	:	702-383-9890
Telephone Number	:	702-383-9890

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	08/22/2020

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