Provider Demographics
NPI:1760065775
Name:COMMUNITY HEALTH RESOURCES LLC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GINALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTAZAR-SUMBANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-328-4851
Mailing Address - Street 1:6069 S FORT APACHE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5579
Mailing Address - Country:US
Mailing Address - Phone:702-328-4851
Mailing Address - Fax:
Practice Address - Street 1:2215 RENAISSANCE DR STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6729
Practice Address - Country:US
Practice Address - Phone:725-240-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty