MEDICARE: PEACE LOVE UNITY RESPECT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1275099798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE LOVE UNITY RESPECT

Provider Business Mailing Address
First Line	:	2301 SUPERIOR POSITION ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-3570
Country	:	US
Telephone Number	:	702-237-4940
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 SUPERIOR POSITION ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-3570
Country	:	US
Telephone Number	:	702-237-4940
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KEZIAH PLADNA
Credential	:
Telephone Number	:	702-237-4940

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	02/20/2019

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Directions to “PEACE LOVE UNITY RESPECT ” Practice Location

Language	Start Address	Practice Location

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