MEDICARE: NEUROVINE BEHAVIORAL HEALTH 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1164377149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROVINE BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	4895 BLUSHING HILLS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-3616
Country	:	US
Telephone Number	:	702-478-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1101
Country	:	US
Telephone Number	:	702-478-0404
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH NURSE PRACTITIONER
Name	:	CHIKA OKECHUKWU
Credential	:	DNP
Telephone Number	:	702-210-2763

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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