Healthcare Provider Details

I. General information

NPI: 1649956053
Provider Name (Legal Business Name): LOVE YOURSELF RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 E CALVADA
PAHRUMP NV
89048
US

IV. Provider business mailing address

1503 E CALVADA
PAHRUMP NV
89048
US

V. Phone/Fax

Practice location:
  • Phone: 702-969-8785
  • Fax:
Mailing address:
  • Phone: 702-969-8785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ARIAGNE ARIELLE ROGUE DUAVE
Title or Position: CEO
Credential: RN
Phone: 702-969-8785