Healthcare Provider Details

I. General information

NPI: 1154956167
Provider Name (Legal Business Name): A NEW BEAUTIFUL FUTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N HONOLULU ST APT 110
LAS VEGAS NV
89110-4312
US

IV. Provider business mailing address

50 N HONOLULU ST APT 110
LAS VEGAS NV
89110-4312
US

V. Phone/Fax

Practice location:
  • Phone: 702-470-7664
  • Fax:
Mailing address:
  • Phone: 702-470-7664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KIERA A HALL
Title or Position: OWNER
Credential:
Phone: 702-470-7664