=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992055917
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FROM THE HEART
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2012
-----------------------------------------------------
Last Update Date | 09/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6955 N DURANGO DR STE 1115-718
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89149-4411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-353-1786
-----------------------------------------------------
Fax | 702-965-2455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6955 N DURANGO DR STE 1115-718
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89149-4411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-353-1786
-----------------------------------------------------
Fax | 702-965-2455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. MARY C TORY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-353-1786
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------