MEDICARE: GLC WELLNESS CENTER HEALTH, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1942084298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLC WELLNESS CENTER HEALTH, INC

Provider Business Mailing Address
First Line	:	PO BOX 3543
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60522-3543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S 4TH ST STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6206
Country	:	US
Telephone Number	:	877-767-1692
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. NANCY GRIFFIN
Credential	:
Telephone Number	:	312-730-4355

Provider Enumeration Date	:	08/18/2023
Last Update Date	:	01/08/2025

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