MEDICARE: EARTH RYTHMS WELLNESS CENTER 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1265234793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARTH RYTHMS WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	400 S 4TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S 4TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6201
Country	:	US
Telephone Number	:	702-366-6817
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVINA BUSSEY
Credential	:
Telephone Number	:	702-366-6817

Provider Enumeration Date	:	03/25/2025
Last Update Date	:	03/25/2025

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