MEDICARE: HANDS IN HARMONY WELLNESS 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1891301529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANDS IN HARMONY WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	25 W LA MADRE WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2557
Country	:	US
Telephone Number	:	678-478-6268
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 W LA MADRE WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2557
Country	:	US
Telephone Number	:	678-478-6268
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAVEN HARRIS
Credential	:
Telephone Number	:	678-478-6268

Provider Enumeration Date	:	09/18/2020
Last Update Date	:	09/18/2020

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