Provider Demographics
NPI:1679068589
Name:NORTH LAS VEGAS BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:NORTH LAS VEGAS BEHAVIORAL HEALTH
Other - Org Name:NORTH LAS VEGAS ADULT DAY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-586-5999
Mailing Address - Street 1:3131 W CRAIG RD STE 180
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0861
Mailing Address - Country:US
Mailing Address - Phone:702-469-7897
Mailing Address - Fax:
Practice Address - Street 1:3277 W CRAIG RD STE 100-130
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0792
Practice Address - Country:US
Practice Address - Phone:702-586-5999
Practice Address - Fax:702-586-5991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH LAS VEGAS BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1578935508Medicaid