MEDICARE: 360 HABILITATION 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1265315220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	360 HABILITATION LLC

Provider Business Mailing Address
First Line	:	6605 GRAND MONTECITO PKWY STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0210
Country	:	US
Telephone Number	:	702-403-3089
Fax Number	:

Provider Business Practice Location Address
First Line	:	6605 GRAND MONTECITO PKWY STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0210
Country	:	US
Telephone Number	:	702-403-3089
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. KEONTA DELSHAWN SCRUGGS
Credential	:
Telephone Number	:	702-403-3089

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	07/28/2025

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