MEDICARE: ANTIOCH COMMUNITY SERVICES INC.

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	101Y00000X	Counselor
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1588138010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTIOCH COMMUNITY SERVICES INC.

Provider Business Mailing Address
First Line	:	6935 ALIANTE PKWY STE 109
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-5819
Country	:	US
Telephone Number	:	702-655-4227
Fax Number	:

Provider Business Practice Location Address
First Line	:	6935 ALIANTE PKWY STE 109
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-5819
Country	:	US
Telephone Number	:	702-655-4227
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NAIDA PARSON
Credential	:
Telephone Number	:	702-655-4227

Provider Enumeration Date	:	01/17/2019
Last Update Date	:	07/25/2019

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