| M.a.d.i.c. | |
|
5920 Lavender Breeze St North Las Vegas NV 89081-6848 | |
| (702) 533-6008 | |
| Not Available |
| Full Name | M.a.d.i.c. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5920 Lavender Breeze St, North Las Vegas, Nevada |
| Authorized Official Name and Position | Carmea A Bass (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7025336008 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| M.a.d.i.c. 5920 Lavender Breeze St North Las Vegas NV 89081-6848 Ph: (702) 533-6008 | M.a.d.i.c. 5920 Lavender Breeze St North Las Vegas NV 89081-6848 Ph: (702) 533-6008 |
| NPI Number | 1053817221 |
|---|---|
| Provider Enumeration Date | 04/05/2018 |
| Last Update Date | 12/13/2020 |
| Certification Date | 12/13/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053817221 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Nevada) | Primary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (Nevada) | Secondary |
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