MEDICARE: MY JOURNEY BEHAVIORAL HEALTH 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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1467954230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY JOURNEY BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	4103 W DELHI AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-3419
Country	:	US
Telephone Number	:	702-587-1798
Fax Number	:

Provider Business Practice Location Address
First Line	:	4103 W DELHI AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-3419
Country	:	US
Telephone Number	:	702-587-1798
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EDRECKA WOLRIDGE
Credential	:
Telephone Number	:	702-587-1798

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	03/07/2018

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