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70 South Hwy 160 Suit 104 Pharump NV 89048-8912 | |
| (702) 406-7133 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 70 South Hwy 160 Suit 104, Pharump, Nevada |
| Authorized Official Name and Position | John Okafor (CEO) |
| Authorized Official Contact | 7024067133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7640 Feliz Camino Ave Las Vegas NV 89129-5407 Ph: (702) 406-7133 | 70 South Hwy 160 Suit 104 Pharump NV 89048-8912 Ph: (702) 406-7133 |
| NPI Number | 1205569852 |
|---|---|
| Provider Enumeration Date | 07/01/2022 |
| Last Update Date | 06/19/2024 |
| Certification Date | 06/19/2024 |
| Medicare PECOS PAC ID | 1759735947 |
|---|---|
| Medicare Enrollment ID | O20230921001782 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205569852 | NPI | - | NPPES |
| 120 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Jeremiah C Umeh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225690449 PECOS PAC ID: 3072994664 Enrollment ID: I20220713002713 |