MEDICARE: SIMPLY GENUINE BEHAVIORAL HEALTH 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

General Provider Information

NPI Number	:	1326566530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLY GENUINE BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	1504 DRAGONFLY RANCH LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6797
Country	:	US
Telephone Number	:	702-328-0993
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 DRAGONFLY RANCH LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6797
Country	:	US
Telephone Number	:	702-328-0993
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. BRITTANY SANFORD
Credential	:
Telephone Number	:	702-328-0993

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

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