Provider Demographics
NPI:1003451584
Name:NEVADA REHAB LLC
Entity Type:Organization
Organization Name:NEVADA REHAB LLC
Other - Org Name:VANCE JOHNSON RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-597-5075
Mailing Address - Street 1:7074 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8658
Mailing Address - Country:US
Mailing Address - Phone:352-597-5075
Mailing Address - Fax:352-610-9996
Practice Address - Street 1:2651 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1117
Practice Address - Country:US
Practice Address - Phone:888-828-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility