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General NPI Number Information
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NPI Number | 1235677477
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Entity Type | Organization
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Legal Business Name | 1 LOVE WELLNESS SOCIETY LLC
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Dates
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Enumeration Date | 02/08/2017
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 5940 S RAINBOW BLVD STE 213 RM 1014
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City | LAS VEGAS
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State | NV
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Zip | 89118-2506
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Country | US
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Telephone | 562-714-2146
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Fax |
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Provider Business Mailing Address
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Address Line | 5940 S RAINBOW BLVD STE 213 RM 1014
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City | LAS VEGAS
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State | NV
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Zip | 89118-2506
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Country | US
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Telephone | 562-714-2146
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DENISE MADISON
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Credential |
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Telephone | 562-714-2146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | NV20161704135
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | NV20161704135
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License Number State | NV
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