MEDICARE: REBUILDING TO SUCCESS

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

General Provider Information

NPI Number	:	1376090894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBUILDING TO SUCCESS

Provider Business Mailing Address
First Line	:	3212 CAROLINA MOON AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6476
Country	:	US
Telephone Number	:	724-961-4878
Fax Number	:

Provider Business Practice Location Address
First Line	:	3212 CAROLINA MOON AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081
Country	:	US
Telephone Number	:	724-961-4878
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AMBER CHRISTINE HALL
Credential	:
Telephone Number	:	724-961-4878

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	06/20/2018

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Directions to “REBUILDING TO SUCCESS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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