MEDICARE: NO LONGER BROKEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1265194039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NO LONGER BROKEN

Provider Business Mailing Address
First Line	:	7220 S CIMARRON RD STE 210
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2102
Country	:	US
Telephone Number	:	702-368-2380
Fax Number	:

Provider Business Practice Location Address
First Line	:	7220 S CIMARRON RD STE 210
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2102
Country	:	US
Telephone Number	:	702-368-2380
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. MORGAN RODRIGUEZ
Credential	:
Telephone Number	:	702-368-2380

Provider Enumeration Date	:	10/08/2021
Last Update Date	:	10/08/2021

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Directions to “NO LONGER BROKEN ” Practice Location

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