Provider Demographics
NPI:1518481530
Name:GODSPEED BEHAVIORAL HEALTH L.L.C
Entity Type:Organization
Organization Name:GODSPEED BEHAVIORAL HEALTH L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:ASAMOAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-888-0810
Mailing Address - Street 1:3805 FUSELIER DR
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-3003
Mailing Address - Country:US
Mailing Address - Phone:503-888-0810
Mailing Address - Fax:
Practice Address - Street 1:3805 FUSILIER DR
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:503-888-0810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness