MEDICARE: A PLACE OF HOPE BEHAVIORAL HEALTH SERVICES OF NEVADA

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1801307947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PLACE OF HOPE BEHAVIORAL HEALTH SERVICES OF NEVADA

Provider Business Mailing Address
First Line	:	8631 ISLA VISTA VALLEY CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-7521
Country	:	US
Telephone Number	:	702-787-6150
Fax Number	:

Provider Business Practice Location Address
First Line	:	8631 ISLA VISTA VALLEY CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178
Country	:	US
Telephone Number	:	702-787-6150
Fax Number	:	702-787-6150

Authorized Official
Title or Position	:	CEO/ EXECUTIVE DIRECTOR
Name	:	SHANTAY SARAH COLEMAN
Credential	:
Telephone Number	:	702-787-6150

Provider Enumeration Date	:	10/17/2017
Last Update Date	:	06/09/2018

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