| Paradise Behavioral Health Center Llc | |
|
4912 Cinnamon Spice Ct N Las Vegas NV 89031-2587 | |
| (702) 690-0785 | |
| Not Available |
| Full Name | Paradise Behavioral Health Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4912 Cinnamon Spice Ct, N Las Vegas, Nevada |
| Authorized Official Name and Position | Laquaisha Dantrice Hyder (CEO) |
| Authorized Official Contact | 7026900785 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Paradise Behavioral Health Center Llc 4912 Cinnamon Spice Ct N Las Vegas NV 89031-2587 Ph: () - | Paradise Behavioral Health Center Llc 4912 Cinnamon Spice Ct N Las Vegas NV 89031-2587 Ph: (702) 690-0785 |
| NPI Number | 1023638418 |
|---|---|
| Provider Enumeration Date | 04/26/2020 |
| Last Update Date | 12/04/2020 |
| Certification Date | 12/04/2020 |
| Medicare PECOS PAC ID | 2668880956 |
|---|---|
| Medicare Enrollment ID | O20210427001052 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023638418 | NPI | - | NPPES |
| 1912205394 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | James C Lee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487773537 PECOS PAC ID: 9739226309 Enrollment ID: I20190821001350 |
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