Healthcare Provider Details

I. General information

NPI: 1114843992
Provider Name (Legal Business Name): THRIVING HEARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 W CHEYENNE AVE
LAS VEGAS NV
89030
US

IV. Provider business mailing address

3560 W CHEYENNE AVE
LAS VEGAS NV
89030
US

V. Phone/Fax

Practice location:
  • Phone: 775-425-2374
  • Fax:
Mailing address:
  • Phone: 775-425-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JERMAINE SMITH
Title or Position: PROVIDER
Credential:
Phone: 702-764-8493