Provider Demographics
NPI:1750960043
Name:URBAN HEALTHY MINDS, LLC
Entity type:Organization
Organization Name:URBAN HEALTHY MINDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-540-7671
Mailing Address - Street 1:11500 S EASTERN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5576
Mailing Address - Country:US
Mailing Address - Phone:702-540-7671
Mailing Address - Fax:702-552-7138
Practice Address - Street 1:11500 S EASTERN AVE STE 150
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5576
Practice Address - Country:US
Practice Address - Phone:702-540-7671
Practice Address - Fax:702-552-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1601730466Medicaid
NV1601730466OtherOPEN