Provider Demographics
NPI:1972044287
Name:CENTER FOR BEHAVIORAL HEALTH LAS VEGAS, LLC
Entity Type:Organization
Organization Name:CENTER FOR BEHAVIORAL HEALTH LAS VEGAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS.
Authorized Official - Prefix:
Authorized Official - First Name:BRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-367-9021
Mailing Address - Street 1:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83701-0897
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:160 HUBBARD WAY STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3780
Practice Address - Country:US
Practice Address - Phone:775-829-4472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2961NTC-16261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone