MEDICARE: VEGAS VALLEY BEHAVIORAL HEALTH

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	:	1659680031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEGAS VALLEY BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	2831 SAINT ROSE PKWY STE 307
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4840
Country	:	US
Telephone Number	:	702-232-3462
Fax Number	:	702-589-4881

Provider Business Practice Location Address
First Line	:	2831 SAINT ROSE PKWY STE 307
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4840
Country	:	US
Telephone Number	:	702-232-3462
Fax Number	:	702-589-4881

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ASHLEY NICHOLE COX
Credential	:
Telephone Number	:	702-232-3462

Provider Enumeration Date	:	10/01/2010
Last Update Date	:	10/01/2010

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