MEDICARE: COMMUNITY OF ONE BEHAVIOR 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	:	1750655924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY OF ONE BEHAVIOR HEALTH

Provider Business Mailing Address
First Line	:	3665 SPRING SHOWER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-3787
Country	:	US
Telephone Number	:	702-449-9956
Fax Number	:

Provider Business Practice Location Address
First Line	:	3665 SPRING SHOWER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-3787
Country	:	US
Telephone Number	:	702-449-9956
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MICHAEL LOUIS SMITH
Credential	:
Telephone Number	:	702-449-9956

Provider Enumeration Date	:	03/05/2012
Last Update Date	:	03/05/2012

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