MEDICARE: NEVADA YOUTH ALLIANCE

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1285876243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA YOUTH ALLIANCE

Provider Business Mailing Address
First Line	:	PMB125/7380 S. EASTERN AVE.
Second Line	:	STE. 124
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1552
Country	:	US
Telephone Number	:	702-656-4910
Fax Number	:	702-656-4910

Provider Business Practice Location Address
First Line	:	PMB125/7380 S. EASTERN AVE.
Second Line	:	STE. 124
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1552
Country	:	US
Telephone Number	:	702-656-4910
Fax Number	:	702-656-4910

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID B. OSMAN
Credential	:
Telephone Number	:	702-393-6163

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	04/06/2009

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