MEDICARE: GREEN VALLEY BEHAVIORAL HEALTH 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	:	1629689823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN VALLEY BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	1546 W WARM SPRINGS RD STE 120
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-4326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1546 W WARM SPRINGS RD STE 120
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-4326
Country	:	US
Telephone Number	:	702-451-0000
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DANIELLE CHEUNG
Credential	:
Telephone Number	:	702-885-6463

Provider Enumeration Date	:	08/11/2020
Last Update Date	:	08/11/2020

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