Provider Demographics
NPI:1962829945
Name:MISSION TREATMENT CENTERS
Entity Type:Organization
Organization Name:MISSION TREATMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-818-8106
Mailing Address - Street 1:7371 PRAIRIE FALCON RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0834
Mailing Address - Country:US
Mailing Address - Phone:619-818-8106
Mailing Address - Fax:
Practice Address - Street 1:2887 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1511
Practice Address - Country:US
Practice Address - Phone:702-474-4104
Practice Address - Fax:702-474-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20071612296251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1326354697Medicaid