Provider Demographics
NPI:1932575156
Name:NEVADA INTEGRATED BEHAVIORAL SERVICES INC.
Entity Type:Organization
Organization Name:NEVADA INTEGRATED BEHAVIORAL SERVICES INC.
Other - Org Name:NEVADA TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FESTUS EBONKA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBONKA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-515-9680
Mailing Address - Street 1:1721 E CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1902
Mailing Address - Country:US
Mailing Address - Phone:702-685-0620
Mailing Address - Fax:702-685-9674
Practice Address - Street 1:1721 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1902
Practice Address - Country:US
Practice Address - Phone:702-685-0620
Practice Address - Fax:702-685-9674
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA INTEGRATED BEHAVIORAL SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8352NTC-0261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone