Healthcare Provider Details

I. General information

NPI: 1134008303
Provider Name (Legal Business Name): FREEDOM MINDS NURSING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3518 MONTEPULCIANO LN
HENDERSON NV
89044-1787
US

IV. Provider business mailing address

3518 MONTEPULCIANO LN
HENDERSON NV
89044-1787
US

V. Phone/Fax

Practice location:
  • Phone: 323-203-7694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: JEZRYL CELIZ
Title or Position: OWNER
Credential:
Phone: 323-203-7694