MEDICARE: EAGLE QUEST OF NEVADA, INCORPORATED

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	:	1730214651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE QUEST OF NEVADA, INCORPORATED

Provider Business Mailing Address
First Line	:	4612 EVAN RIDGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-1624
Country	:	US
Telephone Number	:	702-375-1488
Fax Number	:	702-396-4193

Provider Business Practice Location Address
First Line	:	4612 EVAN RIDGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-1624
Country	:	US
Telephone Number	:	702-375-1488
Fax Number	:	702-396-4193

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	DAVID R. DOYLE
Credential	:
Telephone Number	:	702-376-0612

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/22/2020

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