Provider Demographics
NPI:1003233545
Name:FAMILY WELLNESS CENTER
Entity type:Organization
Organization Name:FAMILY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOMAREK
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:775-400-2996
Mailing Address - Street 1:316 GOLDEN PICK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-7412
Mailing Address - Country:US
Mailing Address - Phone:775-400-2996
Mailing Address - Fax:
Practice Address - Street 1:751 BASQUE WAY
Practice Address - Street 2:SUITE D
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7934
Practice Address - Country:US
Practice Address - Phone:775-400-2996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-22
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141195652251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health