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NPI Code Detail

MEDICARE: ANGEL HEART BEHAVIOR HEALTH LLC

MEDICARE: ANGEL HEART BEHAVIOR HEALTH 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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2251S00000XCommunity/Behavioral Health AgencyNV20161605181NV

General Provider Information

NPI Number : 1437601440
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANGEL HEART BEHAVIOR HEALTH LLC
Provider Business Mailing Address
First Line : 2551 S FORT APACHE RD STE 101
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-8700
Country : US
Telephone Number : 702-846-2686
Fax Number :
Provider Business Practice Location Address
First Line : 2551 S FORT APACHE RD STE 101
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-8700
Country : US
Telephone Number : 702-846-2686
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MS. LATASHA CONWAY-HANKSTON
Credential :
Telephone Number : 702-846-2686
Provider Enumeration Date : 10/26/2016
Last Update Date : 03/12/2018

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Directions to “ANGEL HEART BEHAVIOR HEALTH LLC ” Practice Location

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