Healthcare Provider Details

I. General information

NPI: 1740520709
Provider Name (Legal Business Name): FAMILY HOPE BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5642 MAMMOTH MOUNTAIN ST
NORTH LAS VEGAS NV
89081-2419
US

IV. Provider business mailing address

5642 MAMMOTH MOUNTAIN ST
NORTH LAS VEGAS NV
89081-2419
US

V. Phone/Fax

Practice location:
  • Phone: 702-327-3593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA KENDRID
Title or Position: CO-OWNER
Credential:
Phone: 702-327-3593