Healthcare Provider Details

I. General information

NPI: 1760065775
Provider Name (Legal Business Name): COMMUNITY HEALTH RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 RENAISSANCE DR STE C
LAS VEGAS NV
89119-6729
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 725-240-2266
  • Fax:
Mailing address:
  • Phone: 702-328-4851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name: GINALYN BALTAZAR-SUMBANG
Title or Position: MANAGING MEMBER
Credential:
Phone: 702-328-4851