Healthcare Provider Details

I. General information

NPI: 1407362379
Provider Name (Legal Business Name): ANGELS VISITING ANGELS BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8224 W CHARLESTON BLVD STE 1
LAS VEGAS NV
89117-9096
US

IV. Provider business mailing address

8224 W CHARLESTON BLVD STE 1
LAS VEGAS NV
89117-9096
US

V. Phone/Fax

Practice location:
  • Phone: 702-969-3861
  • Fax:
Mailing address:
  • Phone: 702-969-3861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EDNA L COLLIER
Title or Position: CEO
Credential:
Phone: 702-969-3861