MEDICARE: ANGELIC HEALTH TREATMENT CENTER 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	251S00000X	Community/Behavioral Health Agency

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	:	1417451154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC HEALTH TREATMENT CENTER LLC

Provider Business Mailing Address
First Line	:	1233 HEALING WATERS LN
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-1810
Country	:	US
Telephone Number	:	702-738-2482
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 S EASTERN AVE STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5174
Country	:	US
Telephone Number	:	702-738-2482
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CRYSTAL ROMERO
Credential	:
Telephone Number	:	702-738-2482

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	03/19/2018

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