MEDICARE: VALLEY VIEW COMMUNITY CARES BEHAVIORAL HEALTH

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1538499801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY VIEW COMMUNITY CARES BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	2037 ENGLESTAD ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4026
Country	:	US
Telephone Number	:	702-480-6421
Fax Number	:

Provider Business Practice Location Address
First Line	:	2037 ENGLESTAD ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4026
Country	:	US
Telephone Number	:	702-480-6421
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. YLONDA DICKERSON
Credential	:
Telephone Number	:	702-480-6421

Provider Enumeration Date	:	01/07/2010
Last Update Date	:	01/07/2010

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