=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205305869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE ONE WELLNESS CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2018
-----------------------------------------------------
Last Update Date | 11/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 W MONROE AVE APT 145
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89106-2967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-409-4111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 W MONROE AVE APT 145
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89106-2967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-409-4111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMILLA SAYLES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-409-4111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------