Healthcare Provider Details

I. General information

NPI: 1891118949
Provider Name (Legal Business Name): PURE HEARTS BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2014
Last Update Date: 01/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 W ROME BLVD UNIT 1184
NORTH LAS VEGAS NV
89084-5497
US

IV. Provider business mailing address

4325 W ROME BLVD UNIT 1184
NORTH LAS VEGAS NV
89084-5497
US

V. Phone/Fax

Practice location:
  • Phone: 702-885-0827
  • Fax: 702-405-9967
Mailing address:
  • Phone: 702-885-0827
  • Fax: 702-405-9967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MIKI LASHAWN HARRELL
Title or Position: PROVIDER
Credential:
Phone: 720-885-0827