Provider Demographics
NPI:1821789850
Name:NEBO HILL SANCTUARY LLC
Entity Type:Organization
Organization Name:NEBO HILL SANCTUARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SOLEYMANI-ALIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:816-200-7087
Mailing Address - Street 1:18405 KRISTI RD E
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-8567
Mailing Address - Country:US
Mailing Address - Phone:816-200-7087
Mailing Address - Fax:
Practice Address - Street 1:7 E KANSAS ST STE C
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2312
Practice Address - Country:US
Practice Address - Phone:816-200-7087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)