| The Light House Of Love | |
|
730 W Cheyenne Ave Ste 40 North Las Vegas NV 89030-7849 | |
| (702) 633-7923 | |
| (702) 633-7610 |
| Full Name | The Light House Of Love |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 730 W Cheyenne Ave Ste 40, North Las Vegas, Nevada |
| Authorized Official Name and Position | Ladonna Kay Wright Tapplin (OWNER) |
| Authorized Official Contact | 7026337923 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Light House Of Love 730 W Cheyenne Ave Ste 40 North Las Vegas NV 89030-7849 Ph: (702) 633-7923 | The Light House Of Love 730 W Cheyenne Ave Ste 40 North Las Vegas NV 89030-7849 Ph: (702) 633-7923 |
| NPI Number | 1871822197 |
|---|---|
| Provider Enumeration Date | 12/15/2009 |
| Last Update Date | 08/19/2020 |
| Certification Date | 08/19/2020 |
| Medicare PECOS PAC ID | 5193958007 |
|---|---|
| Medicare Enrollment ID | O20140430000828 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871822197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Jacquelyn Ellis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376879155 PECOS PAC ID: 8426183260 Enrollment ID: I20100317001083 |
| Provider Name | Joan M Burley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083022586 PECOS PAC ID: 8921320912 Enrollment ID: I20141202000881 |
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