| Nevada Behavioral Health Center Llc | |
|
3030 S Jones Blvd Ste 104 Las Vegas NV 89146-6793 | |
| (702) 624-7686 | |
| Not Available |
| Full Name | Nevada Behavioral Health Center Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 3030 S Jones Blvd Ste 104, Las Vegas, Nevada |
| Authorized Official Name and Position | Ana Doble (CEO) |
| Authorized Official Contact | 7026247686 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nevada Behavioral Health Center Llc 3030 S Jones Blvd Ste 104 Las Vegas NV 89146-6793 Ph: (702) 624-7686 | Nevada Behavioral Health Center Llc 3030 S Jones Blvd Ste 104 Las Vegas NV 89146-6793 Ph: (702) 624-7686 |
| NPI Number | 1467926758 |
|---|---|
| Provider Enumeration Date | 01/20/2019 |
| Last Update Date | 01/20/2019 |
| Medicare PECOS PAC ID | 0042640484 |
|---|---|
| Medicare Enrollment ID | O20200425000111 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467926758 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Stanley Kidiavayi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902290968 PECOS PAC ID: 7416259551 Enrollment ID: I20160506000245 |
| Provider Name | Ifeanyi C Madu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295295038 PECOS PAC ID: 2860729647 Enrollment ID: I20190816001757 |
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