Healthcare Provider Details

I. General information

NPI: 1528342490
Provider Name (Legal Business Name): HEARTS OF HELPING HANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N. RAINBOW BLVD. SIUTE 148
LASVEGAS NV
89107
US

IV. Provider business mailing address

5420 N. GREENLEY GARDENS ST.
N.LASVEGAS NV
89081
US

V. Phone/Fax

Practice location:
  • Phone: 702-778-8922
  • Fax: 702-778-8789
Mailing address:
  • Phone: 702-778-8922
  • Fax: 702-778-8789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number2600399991
License Number StateNV

VIII. Authorized Official

Name: DONNELL BALDWIN JR.
Title or Position: COMMUNITY MENTOR
Credential:
Phone: 702-797-0546