MEDICARE: MSCC LLC

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	CP0283	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801376108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSCC LLC

Provider Business Mailing Address
First Line	:	16 DELIGHTED AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1393
Country	:	US
Telephone Number	:	404-437-0596
Fax Number	:

Provider Business Practice Location Address
First Line	:	3753 HOWARD HUGHES PKWY STE 234
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-0938
Country	:	US
Telephone Number	:	702-417-1366
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RASHEDA LINNEA ANDERSON
Credential	:
Telephone Number	:	404-437-0596

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	04/29/2019

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