Provider Demographics
NPI:1629517685
Name:PMG HEALTHY LIVING SERVICES, LLC
Entity Type:Organization
Organization Name:PMG HEALTHY LIVING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-604-4595
Mailing Address - Street 1:1555 E FLAMINGO RD STE 158
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-9305
Mailing Address - Country:US
Mailing Address - Phone:702-604-4595
Mailing Address - Fax:888-247-5318
Practice Address - Street 1:1555 E FLAMINGO RD STE 158
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-9305
Practice Address - Country:US
Practice Address - Phone:702-604-4595
Practice Address - Fax:888-247-5318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVE0032382017-5251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health