Provider Demographics
NPI:1922534809
Name:BLESSED HEARTS BEHAVIORAL HEALTH AGENCY
Entity Type:Organization
Organization Name:BLESSED HEARTS BEHAVIORAL HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-619-0157
Mailing Address - Street 1:5457 SUN PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-4053
Mailing Address - Country:US
Mailing Address - Phone:702-619-0157
Mailing Address - Fax:
Practice Address - Street 1:826 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1512
Practice Address - Country:US
Practice Address - Phone:702-586-7409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20171299064251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health