Provider Demographics
NPI:1467703686
Name:ANGELIC HANDS
Entity Type:Organization
Organization Name:ANGELIC HANDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:702-727-9585
Mailing Address - Street 1:4525 S SANDHILL RD STE 115
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5956
Mailing Address - Country:US
Mailing Address - Phone:702-547-9972
Mailing Address - Fax:702-547-9974
Practice Address - Street 1:4525 S SANDHILL RD STE 115
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5956
Practice Address - Country:US
Practice Address - Phone:702-547-9972
Practice Address - Fax:702-547-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2001636-320251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV000Medicaid