Provider Demographics
NPI:1992247266
Name:HALLWAY 2 A HEART
Entity type:Organization
Organization Name:HALLWAY 2 A HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSOCOLGIST
Authorized Official - Phone:702-904-4097
Mailing Address - Street 1:1313 MISTY VIEW COURT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1059
Mailing Address - Country:US
Mailing Address - Phone:702-904-4097
Mailing Address - Fax:702-963-8546
Practice Address - Street 1:1313 MISTY VIEW COURT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-1059
Practice Address - Country:US
Practice Address - Phone:702-904-4097
Practice Address - Fax:702-963-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness