Provider Demographics
NPI:1578124939
Name:CENTERS FOR NEUROBEHAVIORAL EXCELLENCE
Entity Type:Organization
Organization Name:CENTERS FOR NEUROBEHAVIORAL EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP, MAED
Authorized Official - Phone:702-787-7839
Mailing Address - Street 1:2209 BARCHETTA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6028
Mailing Address - Country:US
Mailing Address - Phone:702-787-7839
Mailing Address - Fax:
Practice Address - Street 1:2209 BARCHETTA DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6028
Practice Address - Country:US
Practice Address - Phone:702-787-7839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities