MEDICARE: EISTEAM COMMUNITY WELLNESS CENTERS-LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1164776027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EISTEAM COMMUNITY WELLNESS CENTERS-LLC

Provider Business Mailing Address
First Line	:	1206 COBBLESTONE COVE RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-3075
Country	:	US
Telephone Number	:	702-275-9838
Fax Number	:

Provider Business Practice Location Address
First Line	:	1206 COBBLESTONE COVE RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-3075
Country	:	US
Telephone Number	:	702-275-9838
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF QUALITY ASSURANCE
Name	:	MRS. SHELIA MARCUS
Credential	:
Telephone Number	:	702-275-9838

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	11/03/2012

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Directions to “EISTEAM COMMUNITY WELLNESS CENTERS-LLC ” Practice Location

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