Provider Demographics
NPI:1275362568
Name:MEDICAL AND HOPE BEHAVIORAL HEALTH CENTER LLC
Entity type:Organization
Organization Name:MEDICAL AND HOPE BEHAVIORAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUILANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-242-8703
Mailing Address - Street 1:4225 S EASTERN AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5485
Mailing Address - Country:US
Mailing Address - Phone:858-242-8703
Mailing Address - Fax:
Practice Address - Street 1:4225 S EASTERN AVE STE 8
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5485
Practice Address - Country:US
Practice Address - Phone:858-242-8703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)