Healthcare Provider Details

I. General information

NPI: 1841541620
Provider Name (Legal Business Name): 180 COMMUNITY WELLNESS CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 W. CRAIG ROAD SUITE A
NORTH LAS VEGAS NV
89032-5116
US

IV. Provider business mailing address

3435 W. CRAIG ROAD SUITE A
NORTH LAS VEGAS NV
89032-5116
US

V. Phone/Fax

Practice location:
  • Phone: 702-675-6314
  • Fax: 702-476-9697
Mailing address:
  • Phone: 702-675-6314
  • Fax: 702-476-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5901-C
License Number StateNV

VIII. Authorized Official

Name: MS. ERICKA L SEVERS
Title or Position: CEO
Credential: LCSW
Phone: 702-675-6314