MEDICARE: ACTS OF KINDNESS COMMUNITY 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	251B00000X	Case Management Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1356816318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTS OF KINDNESS COMMUNITY SERVICES, LLC

Provider Business Mailing Address
First Line	:	2008 HAMILTON LN BLDG B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4033
Country	:	US
Telephone Number	:	702-845-9789
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 HAMILTON LN BLDG B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4033
Country	:	US
Telephone Number	:	702-845-9789
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ELIJAH Z MUHAMMAD
Credential	:
Telephone Number	:	702-845-9789

Provider Enumeration Date	:	10/05/2018
Last Update Date	:	10/05/2018

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