Provider Demographics
NPI:1679993778
Name:ANGELS OF NEVADA
Entity type:Organization
Organization Name:ANGELS OF NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-291-6788
Mailing Address - Street 1:801 S RANCHO DR
Mailing Address - Street 2:STE E-3B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3854
Mailing Address - Country:US
Mailing Address - Phone:702-771-5578
Mailing Address - Fax:702-837-0579
Practice Address - Street 1:801 S RANCHO DR
Practice Address - Street 2:STE E-3B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3854
Practice Address - Country:US
Practice Address - Phone:702-771-5578
Practice Address - Fax:702-837-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health