MEDICARE: PRICE PLACE

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	320700000X	Physical Disabilities Residential Treatment Facility		NV

General Provider Information

NPI Number	:	1588112932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRICE PLACE

Provider Business Mailing Address
First Line	:	5576 CY YOUNG DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-5621
Country	:	US
Telephone Number	:	702-444-6080
Fax Number	:	702-446-8133

Provider Business Practice Location Address
First Line	:	5576 CY YOUNG DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-5621
Country	:	US
Telephone Number	:	702-444-6082
Fax Number	:	702-446-8133

Authorized Official
Title or Position	:	OWNER
Name	:	MISS BRANDI ROCHELLE BROOKS
Credential	:
Telephone Number	:	702-444-6082

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	09/14/2016

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Directions to “PRICE PLACE ” Practice Location

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