Emancipation Health & Wellness LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

NV20181050463 Issued in NV

Legal business name

EMANCIPATION HEALTH & WELLNESS LLC

Practice address

222 S Rainbow Blvd Ste 111
Las Vegas, NV 89145-5343

Phone

(702) 478-8205

NPI assigned

Jan 25, 2018

Organization subpart

No

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

Authorized official

Name

Glen Tyrone Chambers

Title

Owner

Phone

(310) 756-9965

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1516838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516838400000",
    "number": "1184122012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 S RAINBOW BLVD STE 111",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891455343",
            "telephone_number": "702-478-8205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S RAINBOW BLVD STE 111",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891455343",
            "telephone_number": "702-478-8205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMANCIPATION HEALTH & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-25",
        "last_updated": "2018-01-25",
        "status": "A",
        "authorized_official_last_name": "CHAMBERS",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "TYRONE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-756-9965"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NV",
            "license": "NV20181050463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.