MEDICARE: RESTORATIVE BEHAVIORAL HEALTH 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

General Provider Information

NPI Number	:	1760817605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATIVE BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	5135 CAMINO AL NORTE STE 261
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2419
Country	:	US
Telephone Number	:	702-806-6195
Fax Number	:	702-586-0143

Provider Business Practice Location Address
First Line	:	5135 CAMINO AL NORTE STE 261
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2419
Country	:	US
Telephone Number	:	702-806-6195
Fax Number	:	702-586-0143

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BRITTNEY COLLINS JEFFERSON
Credential	:
Telephone Number	:	702-806-6195

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	09/11/2013

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