NPIMap

Organization Active NPI

Pro-Health Therapeutic & Empowerment Services LLC

Doing business as Pro-Health Wellness Group

  • Community/Behavioral Health Agency
  • Las Vegas, NV
National Provider Identifier
1013330695
Registry record updated Nov 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PRO-HEALTH THERAPEUTIC & EMPOWERMENT SERVICES LLC
Doing business as
Pro-Health Wellness Group
Practice address
2755 E Desert Inn Rd Ste 260
Las Vegas, NV 89121-3690
Phone
(702) 490-9009
Fax
(866) 737-6147
NPI assigned
Feb 2, 2014
Last updated
Nov 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Keisha GrahamNPI 1063780500
Title
Operations
Phone
(702) 490-9009

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

2755 E Desert Inn Rd Ste 260
Las Vegas, NV 89121-3690

Mailing address

2620 S Maryland Pkwy # 14-199
Las Vegas, NV 89109-8300
Phone (702) 490-9009

Other identifiers 2

IdentifierTypeStateIssuer
1015873316MedicaidNV
1063780500MedicaidNV

Other names 1

  • Pro-Health Wellness Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160224002917 NV Part B Supplier - Clinic/Group Practice 4688979909 Receives reassigned benefits from 4 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory
Tax ID family
Pro-Health Therapeutic Emp4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2620 S Maryland Pkwy
#14199
Las Vegas, NV 89109

2755 E Desert Inn Rd
Ste 130
Las Vegas, NV 89121

3376 S Eastern Ave
#188A
Las Vegas, NV 89169

3376 S Eastern Ave
Ste 186
Las Vegas, NV 89169
Phone (702) 373-1265

Practitioners & affiliated clinicians

Practitioners 57

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 57

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732924800000",
    "number": "1013330695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 S MARYLAND PKWY # 14-199",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891098300",
            "telephone_number": "702-490-9009",
            "fax_number": "866-737-6147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2755 E DESERT INN RD STE 260",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891213690",
            "telephone_number": "702-490-9009",
            "fax_number": "866-737-6147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO-HEALTH THERAPEUTIC & EMPOWERMENT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-02",
        "last_updated": "2024-11-30",
        "certification_date": "2024-11-30",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "KEISHA",
        "authorized_official_title_or_position": "OPERATIONS",
        "authorized_official_telephone_number": "702-490-9009"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1015873316",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063780500",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro-Health Wellness Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.