MEDICARE: MISSION 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	NV20131118652	NV

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	:	1275876757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION FAMILY SERVICES

Provider Business Mailing Address
First Line	:	8670 W CHEYENNE AVENUE
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7457
Country	:	US
Telephone Number	:	702-518-0863
Fax Number	:	702-644-0652

Provider Business Practice Location Address
First Line	:	3417 OSIANA AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-7236
Country	:	US
Telephone Number	:	702-232-4380
Fax Number	:	702-644-0652

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. SHELL A CARTER
Credential	:
Telephone Number	:	702-232-4380

Provider Enumeration Date	:	04/03/2013
Last Update Date	:	05/24/2013

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Directions to “MISSION FAMILY SERVICES ” Practice Location

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