Provider Demographics
NPI:1639683469
Name:CCF HEALTH & BEHAVIORAL LLC
Entity Type:Organization
Organization Name:CCF HEALTH & BEHAVIORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTWON
Authorized Official - Middle Name:
Authorized Official - Last Name:TELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-285-4138
Mailing Address - Street 1:5109 ACKABURG CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2148
Mailing Address - Country:US
Mailing Address - Phone:702-285-4138
Mailing Address - Fax:
Practice Address - Street 1:5109 ACKABURG CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2148
Practice Address - Country:US
Practice Address - Phone:702-285-4138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities