MEDICARE: FIELDS OF WELLNESS HOMES INC

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	323P00000X	Psychiatric Residential Treatment Facility	1001986083	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	:	1679801245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIELDS OF WELLNESS HOMES INC

Provider Business Mailing Address
First Line	:	1529 DUHAMEL WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-7937
Country	:	US
Telephone Number	:	702-813-6573
Fax Number	:	702-629-4371

Provider Business Practice Location Address
First Line	:	1529 DUHAMEL WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-7937
Country	:	US
Telephone Number	:	702-813-6573
Fax Number	:	702-629-4371

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. PATRICIA GAIL CALDWELL
Credential	:
Telephone Number	:	702-813-6573

Provider Enumeration Date	:	11/19/2009
Last Update Date	:	11/19/2009

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