Provider Demographics
NPI:1528584349
Name:ACTIVE BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:ACTIVE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:LLAUGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-981-1153
Mailing Address - Street 1:2600 S TOWN CENTER DR
Mailing Address - Street 2:2042
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2064
Mailing Address - Country:US
Mailing Address - Phone:702-981-1153
Mailing Address - Fax:702-974-4555
Practice Address - Street 1:2600 S TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-2064
Practice Address - Country:US
Practice Address - Phone:702-981-1153
Practice Address - Fax:702-981-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1063950608Medicaid