Healthcare Provider Details

I. General information

NPI: 1124815113
Provider Name (Legal Business Name): I AM ME HAVEN TO HEALTH , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 FAIRWAY CIR
LAS VEGAS NV
89108-1106
US

IV. Provider business mailing address

3808 FAIRWAY CIR
LAS VEGAS NV
89108-1106
US

V. Phone/Fax

Practice location:
  • Phone: 725-867-1130
  • Fax: 725-333-8966
Mailing address:
  • Phone: 678-812-9764
  • Fax: 725-333-8966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANTOINETTE MIMS
Title or Position: EXECUTIVE DIRECTOR
Credential: AABA, CHW I
Phone: 678-812-9764