Basic Information
| Provider Information | |||||||||
| NPI: | 1093249484 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LMS FRESHSTART LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 187 RUIDOSO LN | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89074 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 6025920503 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4660 S EASTERN AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891196139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024788205 | ||||||||
| FaxNumber: | 7024785266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2017 | ||||||||
| LastUpdateDate: | 04/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | MERCEDES | ||||||||
| AuthorizedOfficialMiddleName: | KENISHA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6026393506 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | NV20171166360 | NV | Y | Agencies | Community/Behavioral Health |
No ID Information.