MEDICARE: HEALTHY MIND BODY & SPIRIT 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1538558929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY MIND BODY & SPIRIT LLC.

Provider Business Mailing Address
First Line	:	7739 CASCADE BLUFFS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-0460
Country	:	US
Telephone Number	:	702-810-1109
Fax Number	:

Provider Business Practice Location Address
First Line	:	7739 CASCADE BLUFFS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123
Country	:	US
Telephone Number	:	702-810-1109
Fax Number	:

Authorized Official
Title or Position	:	BST
Name	:	MISS AMIRA FRANSO TOMA
Credential	:
Telephone Number	:	702-810-1109

Provider Enumeration Date	:	01/22/2015
Last Update Date	:	01/22/2015

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