Provider Demographics
NPI:1528687530
Name:RESTORATIVE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:RESTORATIVE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:COLLINS-JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCADCI
Authorized Official - Phone:702-853-6727
Mailing Address - Street 1:5135 CAMINO AL NORTE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2387
Mailing Address - Country:US
Mailing Address - Phone:702-853-6727
Mailing Address - Fax:702-853-6728
Practice Address - Street 1:5135 CAMINO AL NORTE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2387
Practice Address - Country:US
Practice Address - Phone:702-853-6727
Practice Address - Fax:702-853-6728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESTORATIVE BEHAVIORAL HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1336575521Medicaid
NV1669779930Medicaid
NV1982135851Medicaid