Provider Demographics
NPI:1053967265
Name:PRO-HEALTH THERAPEUTIC & EMPOWERMENT SERVICES LLC
Entity type:Organization
Organization Name:PRO-HEALTH THERAPEUTIC & EMPOWERMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-490-9009
Mailing Address - Street 1:3235 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3310
Mailing Address - Country:US
Mailing Address - Phone:702-490-9009
Mailing Address - Fax:866-737-6147
Practice Address - Street 1:3235 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3310
Practice Address - Country:US
Practice Address - Phone:702-490-9009
Practice Address - Fax:866-737-6147
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROHEALTH THERAPEUTIC & EMPOWERMENT SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty