MEDICARE: H.E.R.O.S UNITED 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

General Provider Information

NPI Number	:	1821505736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H.E.R.O.S UNITED LLC

Provider Business Mailing Address
First Line	:	10631 GIBBOUS MOON DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6493
Country	:	US
Telephone Number	:	310-904-2899
Fax Number	:

Provider Business Practice Location Address
First Line	:	10631 GIBBOUS MOON DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6493
Country	:	US
Telephone Number	:	310-904-2899
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SEMAJ WHITE
Credential	:
Telephone Number	:	702-720-0904

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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