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3017 W Charleston Blvd Ste 70 Las Vegas NV 89102-1928 | |
| (702) 822-1188 | |
| (702) 822-2020 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3017 W Charleston Blvd Ste 70, Las Vegas, Nevada |
| Authorized Official Name and Position | Robert Lynn Horne (OWNER) |
| Authorized Official Contact | 7028221188 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
840 S Rancho Dr Ste 4-244 Las Vegas NV 89106-3837 Ph: (702) 301-2555 | 3017 W Charleston Blvd Ste 70 Las Vegas NV 89102-1928 Ph: (702) 822-1188 |
| NPI Number | 1558544841 |
|---|---|
| Provider Enumeration Date | 12/10/2007 |
| Last Update Date | 03/20/2024 |
| Certification Date | 05/10/2022 |
| Medicare PECOS PAC ID | 4981655149 |
|---|---|
| Medicare Enrollment ID | O20050204000120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558544841 | NPI | - | NPPES |
| 002002776 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 5311 (Nevada) | Primary |
| Provider Name | Robert L Horne |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104994045 PECOS PAC ID: 9335190594 Enrollment ID: I20050208000205 |
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