Provider Demographics
NPI:1205569852
Name:KENEY BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:KENEY BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OKAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-406-7133
Mailing Address - Street 1:7640 FELIZ CAMINO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-5407
Mailing Address - Country:US
Mailing Address - Phone:702-406-7133
Mailing Address - Fax:
Practice Address - Street 1:70 SOUTH HWY 160 SUIT 104
Practice Address - Street 2:
Practice Address - City:PHARUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-8912
Practice Address - Country:US
Practice Address - Phone:702-406-7133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV120Medicaid