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General NPI Number Information
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NPI Number | 1336809581
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Entity Type | Organization
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Legal Business Name | PURE HEARTS BHC
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Dates
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Enumeration Date | 12/28/2021
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 4325 W ROME BLVD APT 2118
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89084-5478
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Country | US
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Telephone | 725-242-3088
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Fax |
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Provider Business Mailing Address
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Address Line | 4325 W ROME BLVD APT 2118
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89084-5478
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Country | US
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Telephone | 725-242-3088
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Fax |
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Authorized Official
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Title or Position | CASE MANAGER
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Name | MIKI LASHAWN HARRELL
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Credential |
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Telephone | 725-242-3088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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