MEDICARE: CENTENNIAL FAMILY SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251S00000X	Community/Behavioral Health Agency
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1902167653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTENNIAL FAMILY SERVICES

Provider Business Mailing Address
First Line	:	3560 W CHEYENNE AVE
Second Line	:	SUITE 130
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8260
Country	:	US
Telephone Number	:	702-258-8023
Fax Number	:

Provider Business Practice Location Address
First Line	:	3560 W CHEYENNE AVE
Second Line	:	SUITE 130
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8260
Country	:	US
Telephone Number	:	702-258-8023
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	STEPHENIA BURSEY
Credential	:
Telephone Number	:	702-258-8023

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	12/18/2013

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