Provider Demographics
NPI:1629659701
Name:ESSENTIAL CLINIC LLC
Entity Type:Organization
Organization Name:ESSENTIAL CLINIC LLC
Other - Org Name:ESSENTIAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:725-241-5252
Mailing Address - Street 1:600 W SUNSET RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-4112
Mailing Address - Country:US
Mailing Address - Phone:725-241-5252
Mailing Address - Fax:725-241-7474
Practice Address - Street 1:600 W SUNSET RD STE 102
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4112
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1326595125OtherFAMILY NURSE PRACTITIONER AND PSYCHIATRIC NURSE PRACTITIONER