Provider Demographics
NPI:1912486564
Name:HEALING ANGELS BEHAVIORAL HEALTH SERVICE
Entity Type:Organization
Organization Name:HEALING ANGELS BEHAVIORAL HEALTH SERVICE
Other - Org Name:HEALING ANGELS BEHAVIORAL HEALTH SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-423-7133
Mailing Address - Street 1:4214 PALAMOS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-2621
Mailing Address - Country:US
Mailing Address - Phone:702-423-7133
Mailing Address - Fax:
Practice Address - Street 1:4214 PALAMOS DRIVE NORTH LAS VEGAS, NV 89032
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8903
Practice Address - Country:US
Practice Address - Phone:702-423-7133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20181532283251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========Medicaid