MEDICARE: ACHOR VALLEY THERAPY SERVICES 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	251S00000X	Community/Behavioral Health Agency		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	:	1295264513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACHOR VALLEY THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	6404 PINE WILLOWS CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1305
Country	:	US
Telephone Number	:	702-467-6133
Fax Number	:

Provider Business Practice Location Address
First Line	:	6404 PINE WILLOWS CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1305
Country	:	US
Telephone Number	:	702-467-6133
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KARTAYSA BERRY
Credential	:
Telephone Number	:	702-467-6133

Provider Enumeration Date	:	06/09/2017
Last Update Date	:	07/21/2022

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