MEDICARE: NEURO WELLNESS CENTERS OF AMERICA, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1477051498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO WELLNESS CENTERS OF AMERICA, LLC

Provider Business Mailing Address
First Line	:	9734 W SAMPLE RD STE B
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4004
Country	:	US
Telephone Number	:	305-458-8378
Fax Number	:	786-664-3342

Provider Business Practice Location Address
First Line	:	9734 W SAMPLE RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065
Country	:	US
Telephone Number	:	305-458-8378
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. RACHELLE H WEISS LAHN
Credential	:
Telephone Number	:	954-903-1323

Provider Enumeration Date	:	01/24/2018
Last Update Date	:	07/27/2018

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