MEDICARE: HEALTHCARE & WELLNESS ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1083296511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCARE & WELLNESS ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	5070 PENRYN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7059
Country	:	US
Telephone Number	:	702-401-4749
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 E FLAMINGO RD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5064
Country	:	US
Telephone Number	:	702-478-4507
Fax Number	:	702-478-4805

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MARIE MATTA
Credential	:
Telephone Number	:	702-401-4749

Provider Enumeration Date	:	04/23/2021
Last Update Date	:	04/23/2021

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