MEDICARE: HARMONY WELLNESS

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	251S00000X	Community/Behavioral Health Agency
2	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356980080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARMONY WELLNESS

Provider Business Mailing Address
First Line	:	1019 FELIX PALM AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-0269
Country	:	US
Telephone Number	:	702-413-2925
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 FELIX PALM AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-0269
Country	:	US
Telephone Number	:	702-413-2925
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DONTE BOYKIN
Credential	:
Telephone Number	:	702-423-2925

Provider Enumeration Date	:	12/28/2019
Last Update Date	:	12/28/2019

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Directions to “HARMONY WELLNESS ” Practice Location

Language	Start Address	Practice Location

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