MEDICARE: AMANI RECOVERY & RESILIENCY CENTERS, 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1164141321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANI RECOVERY & RESILIENCY CENTERS, LLC

Provider Business Mailing Address
First Line	:	2810 W CHARLESTON BLVD STE 61
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1906
Country	:	US
Telephone Number	:	725-201-0417
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 W CHARLESTON BLVD STE 61
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1906
Country	:	US
Telephone Number	:	725-201-0417
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LINDA C ABRAMS
Credential	:	LMS
Telephone Number	:	702-300-4832

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	08/23/2022

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