MEDICARE: A NEW YOU 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1063903144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A NEW YOU LLC

Provider Business Mailing Address
First Line	:	3055 S NELLIS BLVD APT 1074
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7702
Country	:	US
Telephone Number	:	702-336-9032
Fax Number	:

Provider Business Practice Location Address
First Line	:	3055 S NELLIS BLVD APT 1074
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7702
Country	:	US
Telephone Number	:	702-336-9032
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHARON D PERKINS
Credential	:
Telephone Number	:	702-336-9032

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	05/23/2018

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Directions to “A NEW YOU LLC ” Practice Location

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