Provider Demographics
NPI:1538688817
Name:ANGEL HEART BEHAVIOR HEALTH LLC
Entity Type:Organization
Organization Name:ANGEL HEART BEHAVIOR HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY-HANKSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-846-2686
Mailing Address - Street 1:2551 S FORT APACHE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8700
Mailing Address - Country:US
Mailing Address - Phone:702-846-2686
Mailing Address - Fax:
Practice Address - Street 1:2551 S FORT APACHE RD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8700
Practice Address - Country:US
Practice Address - Phone:702-846-2686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGEL HEART BEHAVIOR HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-18
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty