MEDICARE: HEBRON BEHAVIORAL HEALTH

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	:	1245772813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEBRON BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	848 N RAINBOW BLVD
Second Line	:	UNIT 2063
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1103
Country	:	US
Telephone Number	:	855-432-7662
Fax Number	:	888-812-4428

Provider Business Practice Location Address
First Line	:	1600 E DESERT INN RD
Second Line	:	SUITE 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2525
Country	:	US
Telephone Number	:	855-432-7662
Fax Number	:	888-812-4428

Authorized Official
Title or Position	:	CEO
Name	:	ROSE M HOWARD
Credential	:	LCPC, NCC, MAC IAADC
Telephone Number	:	855-432-7662

Provider Enumeration Date	:	11/14/2016
Last Update Date	:	11/18/2016

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