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NPI Code Detail

MEDICARE: PURE LIFE LLC

MEDICARE: PURE LIFE 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
1251S00000XCommunity/Behavioral Health AgencyNV20181591545NV

General Provider Information

NPI Number : 1790265544
Entity Type Code : Organization
Provider Name (Legal Business Name) : PURE LIFE LLC
Provider Business Mailing Address
First Line : 2513 BRAVE HEART AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-0685
Country : US
Telephone Number : 951-667-5754
Fax Number :
Provider Business Practice Location Address
First Line : 2513 BRAVE HEART AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-0685
Country : US
Telephone Number : 951-667-5754
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KARLONDRA WILLIAMS
Credential :
Telephone Number : 773-701-3956
Provider Enumeration Date : 08/20/2018
Last Update Date : 08/20/2018

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Directions to “PURE LIFE LLC ” Practice Location

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