MEDICARE: COMMUNITY HEALTH RESOURCES 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	103TH0004X	Health Psychologist

General Provider Information

NPI Number	:	1760065775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH RESOURCES LLC

Provider Business Mailing Address
First Line	:	6069 S FORT APACHE RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5579
Country	:	US
Telephone Number	:	702-328-4851
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 RENAISSANCE DR STE C
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6729
Country	:	US
Telephone Number	:	725-240-2266
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	GINALYN BALTAZAR-SUMBANG
Credential	:
Telephone Number	:	702-328-4851

Provider Enumeration Date	:	04/29/2021
Last Update Date	:	04/29/2021

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