Provider Demographics
NPI:1891118949
Name:PURE HEARTS BEHAVIORAL HEALTHCARE
Entity type:Organization
Organization Name:PURE HEARTS BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MIKI
Authorized Official - Middle Name:LASHAWN
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-885-0827
Mailing Address - Street 1:4325 W ROME BLVD
Mailing Address - Street 2:UNIT 1184
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-5497
Mailing Address - Country:US
Mailing Address - Phone:702-885-0827
Mailing Address - Fax:702-405-9967
Practice Address - Street 1:4325 W ROME BLVD
Practice Address - Street 2:UNIT 1184
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-5497
Practice Address - Country:US
Practice Address - Phone:702-885-0827
Practice Address - Fax:702-405-9967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-26
Last Update Date:2014-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1790106821Medicaid