MEDICARE: MCFADDEN HOLDINGS LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1932680592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCFADDEN HOLDINGS LLC

Provider Business Mailing Address
First Line	:	8604 COPPER MOUNTAIN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7610
Country	:	US
Telephone Number	:	702-574-5475
Fax Number	:

Provider Business Practice Location Address
First Line	:	8604 COPPER MOUNTAIN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7610
Country	:	US
Telephone Number	:	702-574-5475
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAYQUAN STEWART
Credential	:
Telephone Number	:	702-628-3680

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	03/03/2019

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