1053806745 NPI number — HUMBLE STEPS BHS

Table of content: (NPI 1053806745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053806745 NPI number — HUMBLE STEPS BHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMBLE STEPS BHS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053806745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7345 S DURANGO DR # B107-137
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89113-3653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-764-8440
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3450 W CHEYENNE AVE STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89032-8225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-269-1500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BELOTE-BINFORD
Authorized Official First Name:
ANTOINETTE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-764-8440

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  NV20181357901 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)