Basic Information
| Provider Information | |||||||||
| NPI: | 1962829945 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MISSION TREATMENT CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7371 PRAIRIE FALCON RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6198188106 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2887 S MARYLAND PKWY | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891091511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024744104 | ||||||||
| FaxNumber: | 7024744108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2014 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | LEWISON | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6198188106 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | NV20071612296 | NV | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1326354697 | 05 | NV | MEDICAID |