MEDICARE: LAS VEGAS ADDICTION HEALING CENTER (ALLEN) PC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1699239863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS ADDICTION HEALING CENTER (ALLEN) PC

Provider Business Mailing Address
First Line	:	7391 W CHARLESTON BLVD STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1577
Country	:	US
Telephone Number	:	702-823-8277
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 N GREEN VALLEY PKWY STE 5B
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5889
Country	:	US
Telephone Number	:	702-444-4007
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	RACHEL BOYLE
Credential	:
Telephone Number	:	702-823-8277

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	11/10/2021

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