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NPI Code Detail

MEDICARE: CREATIVE MINDS BEHAVIORAL HEALTH

MEDICARE: CREATIVE MINDS BEHAVIORAL HEALTH
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
1320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1902330780
Entity Type Code : Organization
Provider Name (Legal Business Name) : CREATIVE MINDS BEHAVIORAL HEALTH
Provider Business Mailing Address
First Line : 1809 LUNA ALEGRE ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-7368
Country : US
Telephone Number : 702-201-8105
Fax Number :
Provider Business Practice Location Address
First Line : 1809 LUNA ALEGRE ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-7368
Country : US
Telephone Number : 702-201-8105
Fax Number :
Authorized Official
Title or Position : OWNER
Name : PRENISE APRIL REID
Credential :
Telephone Number : 702-201-8105
Provider Enumeration Date : 04/18/2017
Last Update Date : 04/18/2017

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Directions to “CREATIVE MINDS BEHAVIORAL HEALTH ” Practice Location

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