MEDICARE: INFINITE POSSIBILITIES BEHAVIORAL HEALTHCARE LLC

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	:	1598202244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITE POSSIBILITIES BEHAVIORAL HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	650 S TOWN CENTER DR
Second Line	:	#2079
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-4419
Country	:	US
Telephone Number	:	702-426-9478
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 S TOWN CENTER DR
Second Line	:	#2079
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-4419
Country	:	US
Telephone Number	:	702-426-9478
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBERS
Name	:	KAIA GILBERT
Credential	:
Telephone Number	:	951-376-0177

Provider Enumeration Date	:	01/19/2017
Last Update Date	:	01/19/2017

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