Provider Demographics
NPI:1275292104
Name:180 COMMUNITY WELLNESS CENTERS, LLC
Entity Type:Organization
Organization Name:180 COMMUNITY WELLNESS CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-675-6314
Mailing Address - Street 1:4344 W CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-2484
Mailing Address - Country:US
Mailing Address - Phone:702-675-6314
Mailing Address - Fax:
Practice Address - Street 1:4344 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2484
Practice Address - Country:US
Practice Address - Phone:702-675-6314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:180 COMMUNITY WELLNESS CENTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency