MEDICARE: EXTENDED FAMILY SERVICES

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

General Provider Information

NPI Number	:	1184045775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENDED FAMILY SERVICES

Provider Business Mailing Address
First Line	:	2909 WHITE PEAKS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-2438
Country	:	US
Telephone Number	:	702-588-2081
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 WHITE PEAKS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-2438
Country	:	US
Telephone Number	:	702-588-2081
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	RASHAD A KIRKLAND
Credential	:
Telephone Number	:	702-588-2081

Provider Enumeration Date	:	12/26/2013
Last Update Date	:	12/26/2013

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Directions to “EXTENDED FAMILY SERVICES ” Practice Location

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