Provider Demographics
NPI:1508522434
Name:JADE HEALTH LLC
Entity Type:Organization
Organization Name:JADE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:702-793-4024
Mailing Address - Street 1:3805 S 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-4126
Mailing Address - Country:US
Mailing Address - Phone:602-505-1621
Mailing Address - Fax:623-907-8781
Practice Address - Street 1:400 S 4TH ST STE 500
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-6207
Practice Address - Country:US
Practice Address - Phone:702-793-4024
Practice Address - Fax:623-248-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty