MEDICARE: THE NATIONAL GAY AND LESBIAN ADOLESCENT SOCIAL 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	253J00000X	Foster Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245650522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE NATIONAL GAY AND LESBIAN ADOLESCENT SOCIAL SERVICES

Provider Business Mailing Address
First Line	:	10175 SPENCER ST
Second Line	:	1072
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-6875
Country	:	US
Telephone Number	:	917-981-0503
Fax Number	:

Provider Business Practice Location Address
First Line	:	10175 SPENCER ST
Second Line	:	1072
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-6875
Country	:	US
Telephone Number	:	917-981-0503
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RAYMOND ARTHUR BESSE
Credential	:	QMHA. LMSW, M.DIV
Telephone Number	:	917-981-0503

Provider Enumeration Date	:	04/24/2014
Last Update Date	:	04/24/2014

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