Provider Demographics
NPI:1225383946
Name:BEACON POINTE NV, LLC
Entity Type:Organization
Organization Name:BEACON POINTE NV, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT CONTRACT WORKER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSR, BST
Authorized Official - Phone:702-439-3367
Mailing Address - Street 1:6350 S RILEY ST APT 232
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1344
Mailing Address - Country:US
Mailing Address - Phone:702-439-3367
Mailing Address - Fax:
Practice Address - Street 1:2810 W CHARLESTON BLVD STE 70
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1909
Practice Address - Country:US
Practice Address - Phone:702-822-1556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health