MEDICARE: OPERATION LOVE BEHAVIOR HEALTH SERVICES

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	:	1487171260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPERATION LOVE BEHAVIOR HEALTH SERVICES

Provider Business Mailing Address
First Line	:	3841 CANARY CEDAR ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-9061
Country	:	US
Telephone Number	:	702-918-4325
Fax Number	:

Provider Business Practice Location Address
First Line	:	3841 CANARY CEDAR ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-9061
Country	:	US
Telephone Number	:	702-918-4325
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRAVONNE HARVEY
Credential	:
Telephone Number	:	702-918-4325

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	07/21/2022

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