Healthcare Provider Details

I. General information

NPI: 1215428560
Provider Name (Legal Business Name): LITTLE ANGELS YOUTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 N HIGHWAY 160 STE 11
PAHRUMP NV
89060-4018
US

IV. Provider business mailing address

220 E HORIZON DR STE H
HENDERSON NV
89015-8001
US

V. Phone/Fax

Practice location:
  • Phone: 702-577-5977
  • Fax:
Mailing address:
  • Phone: 702-577-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JONI STUMPF
Title or Position: OWNER
Credential: BA
Phone: 702-577-5977