MEDICARE: ANGELS REUNITED

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1508409285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS REUNITED

Provider Business Mailing Address
First Line	:	2017 TURTLE BEACH AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-5612
Country	:	US
Telephone Number	:	702-677-4724
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 RAYMERT DR STE 109
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3247
Country	:	US
Telephone Number	:	702-779-6188
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TASHANA JONES
Credential	:	MA
Telephone Number	:	702-677-4724

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	10/24/2019

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Directions to “ANGELS REUNITED ” Practice Location

Language	Start Address	Practice Location

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