MEDICARE: LIFE SOLUTIONS OF NEVADA INC

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

General Provider Information

NPI Number	:	1851716302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE SOLUTIONS OF NEVADA INC

Provider Business Mailing Address
First Line	:	8011 NORTH POINT BLVD SUTIE A
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106
Country	:	US
Telephone Number	:	336-926-6128
Fax Number	:	866-406-4630

Provider Business Practice Location Address
First Line	:	3164 W. CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	336-926-6128
Fax Number	:	866-406-4630

Authorized Official
Title or Position	:	CEO
Name	:	MR. ANDREW AUSTRAILA DINKINS
Credential	:
Telephone Number	:	336-926-6128

Provider Enumeration Date	:	02/20/2014
Last Update Date	:	02/24/2014

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