Healthcare Provider Details

I. General information

NPI: 1669039996
Provider Name (Legal Business Name): SIMPLE LIFE SOLUTIONS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6069 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5579
US

IV. Provider business mailing address

PO BOX 401501
LAS VEGAS NV
89140-1501
US

V. Phone/Fax

Practice location:
  • Phone: 702-858-6455
  • Fax:
Mailing address:
  • Phone: 702-858-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PAULA SHANNON
Title or Position: OWNER
Credential:
Phone: 702-858-6455