MEDICARE: NEW CENTURY BHS, 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	20181322926	NV

General Provider Information

NPI Number	:	1669962759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW CENTURY BHS, LLC

Provider Business Mailing Address
First Line	:	1771 E FLAMINGO RD STE 112B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0851
Country	:	US
Telephone Number	:	725-777-3440
Fax Number	:	725-777-3660

Provider Business Practice Location Address
First Line	:	1771 E FLAMINGO RD STE 111B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0851
Country	:	US
Telephone Number	:	725-777-3440
Fax Number	:	725-777-3660

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MR. GREGORY WOOD
Credential	:
Telephone Number	:	725-777-3440

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	05/14/2018

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