MEDICARE: KEEP SAFE WELLCARE CENTER, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1275132862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEEP SAFE WELLCARE CENTER, LLC

Provider Business Mailing Address
First Line	:	1912 GOODWILL ST
Second Line	:	APT D
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-1232
Country	:	US
Telephone Number	:	702-470-9969
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 GOODWILL ST
Second Line	:	APT D
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-1232
Country	:	US
Telephone Number	:	702-470-9969
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXANDRIA HAL
Credential	:
Telephone Number	:	702-470-9969

Provider Enumeration Date	:	10/23/2020
Last Update Date	:	10/23/2020

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