MEDICARE: ANOTHER HALLWAY 2 HEART 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1649044983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANOTHER HALLWAY 2 HEART LLC

Provider Business Mailing Address
First Line	:	6995 OBANNON DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2906 E CHELSEA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-6313
Country	:	US
Telephone Number	:	702-904-4097
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANA HALL
Credential	:	OWNER
Telephone Number	:	702-904-4097

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	11/07/2023

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Directions to “ANOTHER HALLWAY 2 HEART LLC ” Practice Location

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