Provider Demographics
NPI:1104390038
Name:MINDFUL HEART FAMILY HEALTH LLC
Entity Type:Organization
Organization Name:MINDFUL HEART FAMILY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JIKEALA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-515-6507
Mailing Address - Street 1:8670 W CHEYENNE AVE STE 218
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7457
Mailing Address - Country:US
Mailing Address - Phone:678-515-6507
Mailing Address - Fax:
Practice Address - Street 1:8670 W CHEYENNE AVE STE 218
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129
Practice Address - Country:US
Practice Address - Phone:678-515-6507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINDFUL HEART FAMILY HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty