Provider Demographics
NPI:1124610878
Name:SOAR BEHAVIOR SERVICES NEVADA LLC
Entity type:Organization
Organization Name:SOAR BEHAVIOR SERVICES NEVADA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, MA, BCBA
Authorized Official - Phone:702-987-3133
Mailing Address - Street 1:1712 S STEEN RD
Mailing Address - Street 2:
Mailing Address - City:VERADALE
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8053
Mailing Address - Country:US
Mailing Address - Phone:702-987-3133
Mailing Address - Fax:
Practice Address - Street 1:500 N RAINBOW BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1061
Practice Address - Country:US
Practice Address - Phone:702-987-3133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health