MEDICARE: ANGELS VISITING ANGELS BEHAVIORAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	251B00000X	Case Management Agency
3	251C00000X	Developmentally Disabled Services Day Training Agency
4	251V00000X	Voluntary or Charitable Agency
5	347C00000X	Private Vehicle
6	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1407362379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS VISITING ANGELS BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	8224 W CHARLESTON BLVD STE 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9096
Country	:	US
Telephone Number	:	702-969-3861
Fax Number	:

Provider Business Practice Location Address
First Line	:	8224 W CHARLESTON BLVD STE 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9096
Country	:	US
Telephone Number	:	702-969-3861
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EDNA L COLLIER
Credential	:
Telephone Number	:	702-969-3861

Provider Enumeration Date	:	12/14/2017
Last Update Date	:	12/14/2017

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