MEDICARE: LIFE CARE WELLNESS 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
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1942834965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CARE WELLNESS LLC

Provider Business Mailing Address
First Line	:	5135 CAMINO AL NORTE STE 259
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2419
Country	:	US
Telephone Number	:	702-300-5128
Fax Number	:

Provider Business Practice Location Address
First Line	:	3465 W CRAIG RD STE D
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5121
Country	:	US
Telephone Number	:	702-854-5402
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	JENNY LYN LEDESMA
Credential	:	LMFT
Telephone Number	:	702-854-5402

Provider Enumeration Date	:	02/28/2020
Last Update Date	:	04/05/2024

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Directions to “LIFE CARE WELLNESS LLC ” Practice Location

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