MEDICARE: LIONS CREST L.L.C.

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1861834186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIONS CREST L.L.C.

Provider Business Mailing Address
First Line	:	5420 W SAHARA AVE STE 102-2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0394
Country	:	US
Telephone Number	:	702-485-5050
Fax Number	:	702-485-5207

Provider Business Practice Location Address
First Line	:	5420 W SAHARA AVE STE 102-2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0394
Country	:	US
Telephone Number	:	702-485-5050
Fax Number	:	702-485-5207

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WASCAR CRUZ
Credential	:
Telephone Number	:	702-485-5050

Provider Enumeration Date	:	07/28/2013
Last Update Date	:	10/25/2013

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