MEDICARE: GRADUATE HOUSE

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	:	1780832964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRADUATE HOUSE

Provider Business Mailing Address
First Line	:	513 E LA MADRE WAY
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-3048
Country	:	US
Telephone Number	:	702-596-6940
Fax Number	:

Provider Business Practice Location Address
First Line	:	513 E LA MADRE WAY
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-3048
Country	:	US
Telephone Number	:	702-596-6940
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRINTON COOK
Credential	:
Telephone Number	:	702-596-6940

Provider Enumeration Date	:	08/30/2008
Last Update Date	:	08/30/2008

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Directions to “GRADUATE HOUSE ” Practice Location

Language	Start Address	Practice Location

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