MEDICARE: LIONS CREST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1649537333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIONS CREST LLC

Provider Business Mailing Address
First Line	:	5420 W SAHARA AVE
Second Line	:	SUITE 102
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0394
Country	:	US
Telephone Number	:	702-772-8892
Fax Number	:

Provider Business Practice Location Address
First Line	:	5420 W SAHARA AVE
Second Line	:	SUITE 102
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0394
Country	:	US
Telephone Number	:	702-772-8892
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WASCAR CRUZ
Credential	:
Telephone Number	:	702-772-8892

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	10/16/2013

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Directions to “LIONS CREST LLC ” Practice Location

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