MEDICARE: JECHEBEDS BEHAVIORAL HEALTH 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
2	251S00000X	Community/Behavioral Health Agency		NV

General Provider Information

NPI Number	:	1104359488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JECHEBEDS BEHAVIORAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	420 HARRISON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3015
Country	:	US
Telephone Number	:	702-589-1057
Fax Number	:	725-201-2959

Provider Business Practice Location Address
First Line	:	420 HARRISON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3015
Country	:	US
Telephone Number	:	702-589-1057
Fax Number	:	725-201-2959

Authorized Official
Title or Position	:	OWNER
Name	:	MS. WANDA HOWARD
Credential	:	N/A
Telephone Number	:	702-589-1057

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	07/21/2022

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