MEDICARE: LIFE GATEWAY

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	:	1992142186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE GATEWAY

Provider Business Mailing Address
First Line	:	7548 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2778
Country	:	US
Telephone Number	:	702-823-2313
Fax Number	:	702-489-7760

Provider Business Practice Location Address
First Line	:	7548 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2778
Country	:	US
Telephone Number	:	702-823-2313
Fax Number	:	702-489-7760

Authorized Official
Title or Position	:	DIRECTOR
Name	:	STACY THORNTON
Credential	:
Telephone Number	:	702-823-2313

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	05/28/2013

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1669870176 — OLIVIA WILLIAMS-TAYLOR
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Directions to “LIFE GATEWAY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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