MEDICARE: ASHES INTO HOPE LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1528651239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHES INTO HOPE LLC

Provider Business Mailing Address
First Line	:	5230 MORRIS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-7062
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5230 MORRIS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-7062
Country	:	US
Telephone Number	:	702-826-6908
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MYANDA GARY
Credential	:
Telephone Number	:	702-826-6908

Provider Enumeration Date	:	02/12/2021
Last Update Date	:	02/12/2021

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Directions to “ASHES INTO HOPE LLC ” Practice Location

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