Provider Demographics
NPI:1912334012
Name:FELIX, BEVERLY
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:FELIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8216 TIVOLI COVE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7446
Mailing Address - Country:US
Mailing Address - Phone:702-406-8923
Mailing Address - Fax:702-541-9507
Practice Address - Street 1:8216 TIVOLI COVE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7446
Practice Address - Country:US
Practice Address - Phone:702-541-9507
Practice Address - Fax:702-541-9507
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20253340340320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities