MEDICARE: RESILIENCE COMMUNITY WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1063815074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESILIENCE COMMUNITY WELLNESS CENTER

Provider Business Mailing Address
First Line	:	PO BOX 335993
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89033-5993
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5185 CAMINO AL NORTE
Second Line	:	130
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2415
Country	:	US
Telephone Number	:	702-245-7524
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. CARLA LEWIS
Credential	:
Telephone Number	:	702-245-7524

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	10/03/2014

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