MEDICARE: HARDTIME 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1477052686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARDTIME BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	395 HUGHES CENTER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-4803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 HUGHES CENTER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-4803
Country	:	US
Telephone Number	:	121-321-8934
Fax Number	:	213-218-9346

Authorized Official
Title or Position	:	MANAGER
Name	:	BRAIANA JONES
Credential	:
Telephone Number	:	170-255-5122

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

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