Healthcare Provider Details

I. General information

NPI: 1174757611
Provider Name (Legal Business Name): FIELDS OF WELLNESS HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 DUHAMEL WAY 1529 DUHAMEL WAY
NORTH LAS VEGAS NV
89032-7937
US

IV. Provider business mailing address

1529 DUHAMEL WAY
NORTH LAS VEGAS NV
89032-7937
US

V. Phone/Fax

Practice location:
  • Phone: 702-813-6573
  • Fax:
Mailing address:
  • Phone: 702-813-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1001986083
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number1001986083
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1001986083
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1001986083
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number1001986083
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1001986083
License Number StateNV
# 7
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number1001986083
License Number StateNV
# 8
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1001986083
License Number StateNV
# 9
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1001986083
License Number StateNV
# 10
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number1001986083
License Number StateNV
# 11
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1001986083
License Number StateNV

VIII. Authorized Official

Name: MRS. PATRICIA GAIL CALDWELL
Title or Position: FOUNDER/CEO
Credential:
Phone: 702-813-6573