Healthcare Provider Details

I. General information

NPI: 1871178574
Provider Name (Legal Business Name): FAMILY FIRST WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 VILLA GROVE AVE
NORTH LAS VEGAS NV
89030-4706
US

IV. Provider business mailing address

304 S JONES BLVD # 7115
LAS VEGAS NV
89107-2623
US

V. Phone/Fax

Practice location:
  • Phone: 702-626-0015
  • Fax:
Mailing address:
  • Phone: 702-884-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MS. NICOLE BRADSHAW-RANSOM
Title or Position: DIRECTOR
Credential:
Phone: 702-884-0233