MEDICARE: CORRIDOR OF HOPE WELLNESS & CONSULTING, 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	NV20151521890	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528431277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORRIDOR OF HOPE WELLNESS & CONSULTING, LLC

Provider Business Mailing Address
First Line	:	1830 E SAHARA AVE
Second Line	:	103
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3737
Country	:	US
Telephone Number	:	702-370-2960
Fax Number	:	702-543-1777

Provider Business Practice Location Address
First Line	:	1830 E SAHARA AVE
Second Line	:	103
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3737
Country	:	US
Telephone Number	:	702-370-2960
Fax Number	:	702-543-1777

Authorized Official
Title or Position	:	OWNER
Name	:	JUANITA NELSON-BROWN
Credential	:
Telephone Number	:	702-379-4260

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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