MEDICARE: COALDEL BEHAVIORAL HEALTH SERVICES L.L.C.

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	:	1356842041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COALDEL BEHAVIORAL HEALTH SERVICES L.L.C.

Provider Business Mailing Address
First Line	:	2690 AFRICAN VIOLET AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-1957
Country	:	US
Telephone Number	:	978-201-8508
Fax Number	:

Provider Business Practice Location Address
First Line	:	2690 AFRICAN VIOLET AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-1957
Country	:	US
Telephone Number	:	978-201-8508
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH I ARCE
Credential	:
Telephone Number	:	702-485-3555

Provider Enumeration Date	:	02/27/2018
Last Update Date	:	03/08/2018

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