=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467315754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART WELL REHABILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2475 W HORIZON RIDGE PKWY STE 100
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-5946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-478-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2475 W HORIZON RIDGE PKWY STE 100
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-5946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-478-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | VEA EVANGELISTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-639-3411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC3500X
-----------------------------------------------------
Taxonomy Name | Cardiac Rehabilitation Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0404X
-----------------------------------------------------
Taxonomy Name | Cardiac Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------