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NPI Code Detail

MEDICARE: VEGAS WELLNESS TREATMENT CENTER

MEDICARE: VEGAS WELLNESS TREATMENT 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
1324500000XSubstance Abuse Rehabilitation Facility

Other Identifiers

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

General Provider Information

NPI Number : 1578118717
Entity Type Code : Organization
Provider Name (Legal Business Name) : VEGAS WELLNESS TREATMENT CENTER
Provider Business Mailing Address
First Line : 3920 W CHARLESTON BLVD STE N
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1651
Country : US
Telephone Number : 702-478-2819
Fax Number :
Provider Business Practice Location Address
First Line : 3920 W CHARLESTON BLVD STE N
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1651
Country : US
Telephone Number : 702-478-5541
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : IBIRONKE ALAGA
Credential :
Telephone Number : 702-822-0447
Provider Enumeration Date : 08/05/2019
Last Update Date : 08/05/2019

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Directions to “VEGAS WELLNESS TREATMENT CENTER ” Practice Location

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