MEDICARE: NEW LEVELS COMMUNITY DEVELOPMENT

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	C301272003	NV

General Provider Information

NPI Number	:	1780823930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LEVELS COMMUNITY DEVELOPMENT

Provider Business Mailing Address
First Line	:	PO BOX 20074
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89112-2074
Country	:	US
Telephone Number	:	702-510-2642
Fax Number	:

Provider Business Practice Location Address
First Line	:	3880 LEISURE LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2337
Country	:	US
Telephone Number	:	702-510-2642
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. EDITH MONIQUE WYNN
Credential	:
Telephone Number	:	702-510-2642

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	02/11/2009

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Directions to “NEW LEVELS COMMUNITY DEVELOPMENT ” Practice Location

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