MEDICARE: MEADOWS HEALTHCARE CENTER 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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1962155507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEADOWS HEALTHCARE CENTER LLC

Provider Business Mailing Address
First Line	:	3633 LAKESIDE VILLAS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4051
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3633 LAKESIDE VILLAS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4051
Country	:	US
Telephone Number	:	805-890-5247
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	CLAUDIA AYALA
Credential	:
Telephone Number	:	805-890-5247

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	02/03/2022

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