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NPI Code Detail

MEDICARE: IMPACT WELLNESS CENTER,INC

MEDICARE: IMPACT WELLNESS CENTER,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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1902319411
Entity Type Code : Organization
Provider Name (Legal Business Name) : IMPACT WELLNESS CENTER,INC
Provider Business Mailing Address
First Line : 8991 W FLAMINGO RD STE 105
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-0439
Country : US
Telephone Number : 702-586-5001
Fax Number : 702-664-0508
Provider Business Practice Location Address
First Line : 8991 W FLAMINGO RD STE 105
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-0439
Country : US
Telephone Number : 702-586-5001
Fax Number : 702-664-0508
Authorized Official
Title or Position : PRESIDENT/ EXECUTIVE DIRECTOR
Name : CAROLYN PRIDGEON
Credential :
Telephone Number : 702-586-5001
Provider Enumeration Date : 11/07/2017
Last Update Date : 11/07/2017

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Directions to “IMPACT WELLNESS CENTER,INC ” Practice Location

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