Provider Demographics
NPI:1083191738
Name:A ROYAL BEHAVIORAL AGENCY LLC
Entity Type:Organization
Organization Name:A ROYAL BEHAVIORAL AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-430-7987
Mailing Address - Street 1:2595 S CIMARRON RD STE 107
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2697
Mailing Address - Country:US
Mailing Address - Phone:702-430-7987
Mailing Address - Fax:
Practice Address - Street 1:2595 S CIMARRON RD STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2697
Practice Address - Country:US
Practice Address - Phone:702-596-5404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20181514587251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1083191738Medicaid