MEDICARE: FAMILY FIRST 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	261QM2800X	Methadone Clinic
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV20191241196	OTHER	NV	BUSINESS IDENIFIVATION NUMBER

General Provider Information

NPI Number	:	1871178574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	304 S JONES BLVD # 7115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2623
Country	:	US
Telephone Number	:	702-884-0233
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 VILLA GROVE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4706
Country	:	US
Telephone Number	:	702-626-0015
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. NICOLE BRADSHAW-RANSOM
Credential	:
Telephone Number	:	702-884-0233

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	03/15/2021

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