Provider Demographics
NPI:1851782999
Name:NEVADA INTEGRATED BEHAVIORAL SERVICES INC.
Entity Type:Organization
Organization Name:NEVADA INTEGRATED BEHAVIORAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FESTUS
Authorized Official - Middle Name:
Authorized Official - Last Name:EBONKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-515-9680
Mailing Address - Street 1:1721 E CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1902
Mailing Address - Country:US
Mailing Address - Phone:702-515-9680
Mailing Address - Fax:
Practice Address - Street 1:1721 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1902
Practice Address - Country:US
Practice Address - Phone:702-515-9680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131553514261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health