MEDICARE: VISIONZ FAMILY & YOUTH SERVICES OF NEVADA

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1295167831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONZ FAMILY & YOUTH SERVICES OF NEVADA

Provider Business Mailing Address
First Line	:	9404 GRAND GATE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-1397
Country	:	US
Telephone Number	:	615-613-7998
Fax Number	:

Provider Business Practice Location Address
First Line	:	9404 GRAND GATE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-1397
Country	:	US
Telephone Number	:	615-613-7998
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CORTEZ DEWON FEATHERSTON SR.
Credential	:
Telephone Number	:	615-613-7998

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	08/15/2013

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