MEDICARE: INSPIRATION BEHAVIORAL MANAGEMENT

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	:	1770914772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSPIRATION BEHAVIORAL MANAGEMENT

Provider Business Mailing Address
First Line	:	500 N RAINBOW BLVD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1061
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N RAINBOW BLVD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1061
Country	:	US
Telephone Number	:	702-453-4673
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NATHANIEL DAVIS
Credential	:
Telephone Number	:	702-453-4673

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	12/02/2013

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