Provider Demographics
NPI:1164024428
Name:BEAUTIFUL MINDS PRIMARY CARE CLINIC LLC
Entity Type:Organization
Organization Name:BEAUTIFUL MINDS PRIMARY CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHANDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BINION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-813-5413
Mailing Address - Street 1:3550 W CHEYENNE AVE STE 100-130
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8212
Mailing Address - Country:US
Mailing Address - Phone:702-331-1917
Mailing Address - Fax:702-331-5219
Practice Address - Street 1:3550 W CHEYENNE AVE STE 100-130
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8212
Practice Address - Country:US
Practice Address - Phone:702-331-1917
Practice Address - Fax:702-331-5219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty