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General NPI Number Information
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NPI Number | 1346863073
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Entity Type | Organization
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Legal Business Name | AHAVAH CENTER LLC
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 2110 E FLAMINGO RD STE 321
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City | LAS VEGAS
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State | NV
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Zip | 89119-5190
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Country | US
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Telephone | 775-538-5104
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 E FLAMINGO RD STE 321
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City | LAS VEGAS
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State | NV
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Zip | 89119-5190
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Country | US
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Telephone | 775-538-5104
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JSHAUNTAE MARSHALL
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Credential |
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Telephone | 775-538-5104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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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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