Provider Demographics
NPI:1215441191
Name:ST MICHEALS BEHAVIORALHEALTH SERVICES LLC
Entity type:Organization
Organization Name:ST MICHEALS BEHAVIORALHEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MADUABUCHUKWU
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:762-728-0334
Mailing Address - Street 1:8670 W CHEYENNE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7457
Mailing Address - Country:US
Mailing Address - Phone:762-728-0334
Mailing Address - Fax:
Practice Address - Street 1:8670 W CHEYENNE AVE STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7457
Practice Address - Country:US
Practice Address - Phone:762-728-0334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health