MEDICARE: NICHOLAS TAYLOR

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	:	1881001659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLAS TAYLOR

Provider Business Mailing Address
First Line	:	5111 CASPIAN SPRINGS DR. #204
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120
Country	:	US
Telephone Number	:	702-203-3867
Fax Number	:

Provider Business Practice Location Address
First Line	:	5111 CASPIAN SPRINGS DR APT 204
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1155
Country	:	US
Telephone Number	:	702-203-3867
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. NICHOLAS TAYLOR
Credential	:
Telephone Number	:	702-203-3867

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/14/2014

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