MEDICARE: D.O.L.L.S. 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	390200000X	Student in an Organized Health Care Education/Training Program
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1407431430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D.O.L.L.S. LLC

Provider Business Mailing Address
First Line	:	PO BOX 363162
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89036-7162
Country	:	US
Telephone Number	:	702-330-6099
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 FELIX PALM AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0269
Country	:	US
Telephone Number	:	702-330-6099
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAMICA D BOYKIN
Credential	:
Telephone Number	:	702-276-5668

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	03/11/2021

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