NPIMap

Organization Active NPI

Life Gateway

  • Behavior Analyst
  • Las Vegas, NV
National Provider Identifier
1649604554
Registry record updated Aug 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
LIFE GATEWAY
Practice address
7548 W Sahara Ave Ste 101
Las Vegas, NV 89117-2779
Phone
(702) 823-2313
NPI assigned
Aug 27, 2013
Last updated
Aug 27, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cynthia Denise BoldenNPI 1609298256
Title
Provider
Phone
(702) 812-2159

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

7548 W Sahara Ave Ste 101
Las Vegas, NV 89117-2779

Mailing address

1957 Susan St
Las Vegas, NV 89106-2654
Phone (702) 812-2159

Other identifiers 1

IdentifierTypeStateIssuer
1710246921MedicaidNV

National Provider Directory

National Provider Directory
Tax ID family
Life Gateway5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377561600000",
    "number": "1649604554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1957 SUSAN ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891062654",
            "telephone_number": "702-812-2159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7548 W SAHARA AVE STE 101",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891172779",
            "telephone_number": "702-823-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE GATEWAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-27",
        "last_updated": "2013-08-27",
        "status": "A",
        "authorized_official_last_name": "BOLDEN",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "702-812-2159"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710246921",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.