MEDICARE: TREE OF COURAGE FOUNDATION NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	253J00000X	Foster Care Agency
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1831832724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREE OF COURAGE FOUNDATION NCC

Provider Business Mailing Address
First Line	:	9650 COOPER RANCH CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-5808
Country	:	US
Telephone Number	:	402-594-8009
Fax Number	:

Provider Business Practice Location Address
First Line	:	9650 COOPER RANCH CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-5808
Country	:	US
Telephone Number	:	402-594-8009
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHANIN HOWELL
Credential	:
Telephone Number	:	402-594-8009

Provider Enumeration Date	:	04/18/2022
Last Update Date	:	05/06/2022

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