Provider Demographics
NPI:1124815113
Name:I AM ME HAVEN TO HEALTH , LLC
Entity type:Organization
Organization Name:I AM ME HAVEN TO HEALTH , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIMS
Authorized Official - Suffix:
Authorized Official - Credentials:AABA, CHW I
Authorized Official - Phone:678-812-9764
Mailing Address - Street 1:3838 RAYMERT DR # 43838
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3247
Mailing Address - Country:US
Mailing Address - Phone:678-812-9764
Mailing Address - Fax:725-333-8966
Practice Address - Street 1:3838 RAYMERT DR # 43838101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3247
Practice Address - Country:US
Practice Address - Phone:257-867-1130
Practice Address - Fax:725-333-8966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center