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General NPI Number Information
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NPI Number | 1124815113
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Entity Type | Organization
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Legal Business Name | I AM ME HAVEN TO HEALTH , LLC
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 3808 FAIRWAY CIR
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City | LAS VEGAS
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State | NV
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Zip | 89108-1106
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Country | US
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Telephone | 725-867-1130
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Fax | 725-333-8966
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Provider Business Mailing Address
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Address Line | 3808 FAIRWAY CIR
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City | LAS VEGAS
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State | NV
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Zip | 89108-1106
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Country | US
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Telephone | 678-812-9764
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Fax | 725-333-8966
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ANTOINETTE MIMS
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Credential | AABA, CHW I
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Telephone | 678-812-9764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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