Healthcare Provider Details

I. General information

NPI: 1871819375
Provider Name (Legal Business Name): GOD LOVES EVERYTHING ABOUT ME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4717 BOULDER BAY ST
NORTH LAS VEGAS NV
89081-3295
US

IV. Provider business mailing address

PO BOX 335983
NORTH LAS VEGAS NV
89033-5983
US

V. Phone/Fax

Practice location:
  • Phone: 702-787-4341
  • Fax:
Mailing address:
  • Phone: 702-787-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LATIA WHITE
Title or Position: CO-DIRECTOR
Credential:
Phone: 702-787-4341