MEDICARE: ASSERTIVE HEALTH CARE 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	320800000X	Mental Illness Community Based Residential Treatment Facility	P50-03194-3-166019	NV

General Provider Information

NPI Number	:	1518393032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSERTIVE HEALTH CARE SERVICES

Provider Business Mailing Address
First Line	:	3315 E RUSSELL RD
Second Line	:	STE A4 #119
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3459
Country	:	US
Telephone Number	:	702-302-1105
Fax Number	:	702-202-6551

Provider Business Practice Location Address
First Line	:	2451 N RAINBOW BLVD
Second Line	:	APT# 2078
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4502
Country	:	US
Telephone Number	:	702-302-1105
Fax Number	:	702-202-6551

Authorized Official
Title or Position	:	MANAGER/CEO/OWNER
Name	:	MR. VICTOR C SUTTON
Credential	:	MSW
Telephone Number	:	702-302-1105

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/16/2013

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