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General NPI Number Information
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NPI Number | 1609385152
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Entity Type | Organization
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Legal Business Name | ANITAS HEROES
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3656 N RANCHO DR
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City | LAS VEGAS
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State | NV
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Zip | 89130
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Country | US
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Telephone | 949-419-7299
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Fax |
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Provider Business Mailing Address
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Address Line | 3656 N RANCHO DR
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City | LAS VEGAS
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State | NV
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Zip | 89130-3172
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Country | US
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Telephone | 949-419-7299
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAROLYN BEDROSIAN
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Credential |
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Telephone | 949-419-7299
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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 | NV
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