MEDICARE: TAKING A.C.T.I.O.N. ( A COMMITMENT TO IMPACT OUR NEIGHBORHOODS) LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	102X00000X	Poetry Therapist
3	171W00000X	Contractor
4	251B00000X	Case Management Agency
5	251C00000X	Developmentally Disabled Services Day Training Agency
6	251S00000X	Community/Behavioral Health Agency
7	261QD1600X	Developmental Disabilities Clinic/Center
8	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
9	343900000X	Non-emergency Medical Transport (VAN)
10	385H00000X	Respite Care
11	385HR2055X	Child Mental Illness Respite Care
12	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
13	385HR2065X	Child Physical Disabilities Respite Care
14	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1841778990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAKING A.C.T.I.O.N. ( A COMMITMENT TO IMPACT OUR NEIGHBORHOODS) LLC

Provider Business Mailing Address
First Line	:	4780 W ANN RD
Second Line	:	STE 5-282
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3470
Country	:	US
Telephone Number	:	702-818-9305
Fax Number	:

Provider Business Practice Location Address
First Line	:	4780 W ANN RD
Second Line	:	STE 5-282
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3470
Country	:	US
Telephone Number	:	702-818-9305
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER (CEO)
Name	:	BREAUNA C NIEVES
Credential	:
Telephone Number	:	702-591-1231

Provider Enumeration Date	:	07/31/2018
Last Update Date	:	07/20/2023

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