MEDICARE: ADVERSITIES N TIME 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	3245S0500X	Children's Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1144787813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVERSITIES N TIME LLC

Provider Business Mailing Address
First Line	:	5546 CAMINO AL NORTE # 2-304
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0805
Country	:	US
Telephone Number	:	702-329-4991
Fax Number	:	702-920-8849

Provider Business Practice Location Address
First Line	:	820 E CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-1512
Country	:	US
Telephone Number	:	702-329-4991
Fax Number	:	702-920-8848

Authorized Official
Title or Position	:	OWNER
Name	:	CASIA COOK
Credential	:
Telephone Number	:	702-329-4991

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	06/26/2020

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