MEDICARE: SHEPHERDS HEART SERVICES

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	251S00000X	Community/Behavioral Health Agency		NV

General Provider Information

NPI Number	:	1376087700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEPHERDS HEART SERVICES

Provider Business Mailing Address
First Line	:	9050 W TROPICANA AVE UNIT 1155
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8191
Country	:	US
Telephone Number	:	562-203-9014
Fax Number	:	702-330-6515

Provider Business Practice Location Address
First Line	:	9050 W TROPICANA AVE UNIT 1155
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8191
Country	:	US
Telephone Number	:	562-203-9014
Fax Number	:	702-330-6515

Authorized Official
Title or Position	:	OWNER
Name	:	HENRIETTA BINFORD
Credential	:
Telephone Number	:	562-203-9014

Provider Enumeration Date	:	12/03/2016
Last Update Date	:	12/03/2016

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Directions to “SHEPHERDS HEART SERVICES ” Practice Location

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