MEDICARE: OUR STORIES 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	NV20181154008	NV

General Provider Information

NPI Number	:	1093217200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR STORIES LLC

Provider Business Mailing Address
First Line	:	6800 E LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-1119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 E LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-1119
Country	:	US
Telephone Number	:	702-334-8852
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MELVIN JONES II
Credential	:
Telephone Number	:	702-334-8852

Provider Enumeration Date	:	03/03/2018
Last Update Date	:	03/03/2018

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Directions to “OUR STORIES LLC ” Practice Location

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