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NPI Code Detail

MEDICARE: ONE HUNDRED PERCENT WELL LLC

MEDICARE: ONE HUNDRED PERCENT WELL 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
1103K00000XBehavior Analyst103K00000XNV

General Provider Information

NPI Number : 1275824195
Entity Type Code : Organization
Provider Name (Legal Business Name) : ONE HUNDRED PERCENT WELL LLC
Provider Business Mailing Address
First Line : 4559 SPARWOOD DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-8212
Country : US
Telephone Number : 702-275-5190
Fax Number : 702-430-1265
Provider Business Practice Location Address
First Line : 2881 S VALLEY VIEW BLVD
Second Line : SUITE #25
City : LAS VEGAS
State : NV
Zip : 89102-0100
Country : US
Telephone Number : 702-275-5190
Fax Number : 702-430-1265
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. REESE LAMOUNTE THOMAS-MCDADE I
Credential : BSW
Telephone Number : 702-275-5190
Provider Enumeration Date : 04/26/2011
Last Update Date : 04/26/2011

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Directions to “ONE HUNDRED PERCENT WELL LLC ” Practice Location

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