MEDICARE: GLIMMER OF HOPE HEALTH SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV20191661640	OTHER	NV	STATE BUSINESS LICENSE

General Provider Information

NPI Number	:	1225677487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLIMMER OF HOPE HEALTH SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	2375 E TROPICANA AVE # 144
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6564
Country	:	US
Telephone Number	:	702-827-4524
Fax Number	:

Provider Business Practice Location Address
First Line	:	2375 E TROPICANA AVE # 144
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6564
Country	:	US
Telephone Number	:	702-827-4524
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	OMAR ALCID
Credential	:
Telephone Number	:	702-827-4524

Provider Enumeration Date	:	01/05/2020
Last Update Date	:	01/05/2020

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