Provider Demographics
NPI:1790300010
Name:ESPOIR BEHAVIOR HEALTH LLC
Entity Type:Organization
Organization Name:ESPOIR BEHAVIOR HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:GERVINE
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:NGOMA MOUTOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-771-0158
Mailing Address - Street 1:1298 HIGHGATE CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-0762
Mailing Address - Country:US
Mailing Address - Phone:775-771-0158
Mailing Address - Fax:
Practice Address - Street 1:1298 HIGHGATE CT
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-0762
Practice Address - Country:US
Practice Address - Phone:775-771-0158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty