| Illuminated Path Llc | |
|
7351 W Charleston Blvd Ste 140 Las Vegas NV 89117-1572 | |
| (702) 886-0961 | |
| Not Available |
| Full Name | Illuminated Path Llc |
|---|---|
| Speciality | Social Worker |
| Location | 7351 W Charleston Blvd Ste 140, Las Vegas, Nevada |
| Authorized Official Name and Position | Saritha L Farris (OWNER) |
| Authorized Official Contact | 7028860961 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Illuminated Path Llc Po Box 82335 Las Vegas NV 89180-2335 Ph: (702) 886-0961 | Illuminated Path Llc 7351 W Charleston Blvd Ste 140 Las Vegas NV 89117-1572 Ph: (702) 886-0961 |
| NPI Number | 1689138877 |
|---|---|
| Provider Enumeration Date | 01/22/2019 |
| Last Update Date | 01/22/2019 |
| Medicare PECOS PAC ID | 4385984426 |
|---|---|
| Medicare Enrollment ID | O20190327001445 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689138877 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Saritha L Farris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194029785 PECOS PAC ID: 0244517928 Enrollment ID: I20170505001523 |
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