Healthcare Provider Details

I. General information

NPI: 1114877339
Provider Name (Legal Business Name): HEALING HORIZONS HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 E FLAMINGO RD STE 271
LAS VEGAS NV
89119-0802
US

IV. Provider business mailing address

6829 MIDPARK CIR
LAS VEGAS NV
89145-5383
US

V. Phone/Fax

Practice location:
  • Phone: 702-626-1641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RONOLDY FAXAS
Title or Position: CEO
Credential:
Phone: 702-626-1641