Provider Demographics
NPI:1336712975
Name:ILIAD AND ODYSSEY BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:ILIAD AND ODYSSEY BEHAVIORAL HEALTH LLC
Other - Org Name:ILIAD AND ODYSSEY BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:CABRERA
Authorized Official - Last Name:TUAZON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP, PMHNP
Authorized Official - Phone:702-417-3865
Mailing Address - Street 1:PO BOX 400546
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140
Mailing Address - Country:US
Mailing Address - Phone:702-262-0110
Mailing Address - Fax:
Practice Address - Street 1:3110 E SUNSET RD STE K
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-5700
Practice Address - Country:US
Practice Address - Phone:702-262-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ILIAD AND ODYSSEY BEHAVIORAL HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-21
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty