MEDICARE: RENEWED MINDS BHS

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	:	1518434430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWED MINDS BHS

Provider Business Mailing Address
First Line	:	6941 PUETOLLANO DR
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89084-2339
Country	:	US
Telephone Number	:	310-921-0579
Fax Number	:

Provider Business Practice Location Address
First Line	:	6941 PUETOLLANO DR
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89084-2339
Country	:	US
Telephone Number	:	310-921-0579
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RHONDA DENISE KELLY
Credential	:
Telephone Number	:	310-921-0579

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	10/29/2018

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Directions to “RENEWED MINDS BHS ” Practice Location

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