Provider Demographics
NPI:1619310646
Name:EISTEAM COMMUNUTY WELLNESS CENTERS
Entity Type:Organization
Organization Name:EISTEAM COMMUNUTY WELLNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT SERVICES COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:B A DEGREE
Authorized Official - Phone:214-500-7273
Mailing Address - Street 1:1200 HELEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NEVADA
Mailing Address - Zip Code:89081
Mailing Address - Country:UM
Mailing Address - Phone:702-636-9229
Mailing Address - Fax:702-636-9229
Practice Address - Street 1:1200 HELEN AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3721
Practice Address - Country:US
Practice Address - Phone:702-636-9229
Practice Address - Fax:702-636-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health