Provider Demographics
NPI:1750678199
Name:INNOVATION BEHAVIORAL HEALTH SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INNOVATION BEHAVIORAL HEALTH SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:BA; MS STUDENT
Authorized Official - Phone:702-541-3563
Mailing Address - Street 1:1876 VERDE MIRADA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-3844
Mailing Address - Country:US
Mailing Address - Phone:702-541-3563
Mailing Address - Fax:
Practice Address - Street 1:2340 PASEO DEL PRADO STE D305
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4342
Practice Address - Country:US
Practice Address - Phone:866-604-6812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit