MEDICARE: EMBRAISE INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	252Y00000X	Early Intervention Provider Agency
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1861667032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBRAISE INC.

Provider Business Mailing Address
First Line	:	6325 SNAP RIDGE ST UNIT 101
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-3847
Country	:	US
Telephone Number	:	702-370-7842
Fax Number	:

Provider Business Practice Location Address
First Line	:	6325 SNAP RIDGE ST UNIT 101
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-3847
Country	:	US
Telephone Number	:	702-370-7842
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PRISCILLA V DAVIS
Credential	:	M.S.W.
Telephone Number	:	702-370-7842

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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Directions to “EMBRAISE INC. ” Practice Location

Language	Start Address	Practice Location

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