MEDICARE: FIRST STEP SERVICES

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	104357	NV

General Provider Information

NPI Number	:	1790102739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST STEP SERVICES

Provider Business Mailing Address
First Line	:	4909 EL ESTE LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-5596
Country	:	US
Telephone Number	:	702-204-1781
Fax Number	:

Provider Business Practice Location Address
First Line	:	4909 EL ESTE LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-5596
Country	:	US
Telephone Number	:	702-204-1781
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	DEMARIO JACKSON
Credential	:
Telephone Number	:	702-204-1781

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	03/27/2014

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