Provider Demographics
NPI:1912431115
Name:BROOKS FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:BROOKS FAMILY CLINIC LLC
Other - Org Name:BROOKS ADDICTION & COUNSELING MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-570-5200
Mailing Address - Street 1:3550 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 100-A
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8212
Mailing Address - Country:US
Mailing Address - Phone:702-570-5200
Mailing Address - Fax:702-570-5201
Practice Address - Street 1:3550 W CHEYENNE AVE
Practice Address - Street 2:SUITE 100-A
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8212
Practice Address - Country:US
Practice Address - Phone:702-570-5200
Practice Address - Fax:702-570-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6983101YA0400X
NV9037207QA0401X
324500000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children