Provider Demographics
NPI:1568077519
Name:NIRVANA HEALTH
Entity Type:Organization
Organization Name:NIRVANA HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNASEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NARCISO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-379-7571
Mailing Address - Street 1:6732 DIVERS LOONS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2691
Mailing Address - Country:US
Mailing Address - Phone:702-379-7571
Mailing Address - Fax:
Practice Address - Street 1:6732 DIVERS LOONS ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-2691
Practice Address - Country:US
Practice Address - Phone:702-379-7571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty