Provider Demographics
NPI:1376087700
Name:SHEPHERDS HEART SERVICES
Entity Type:Organization
Organization Name:SHEPHERDS HEART SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-203-9014
Mailing Address - Street 1:9050 W TROPICANA AVE UNIT 1155
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8191
Mailing Address - Country:US
Mailing Address - Phone:562-203-9014
Mailing Address - Fax:702-330-6515
Practice Address - Street 1:9050 W TROPICANA AVE UNIT 1155
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8191
Practice Address - Country:US
Practice Address - Phone:562-203-9014
Practice Address - Fax:702-330-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-03
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health