Provider Demographics
NPI:1205305869
Name:CARE ONE WELLNESS CENTER LLC
Entity type:Organization
Organization Name:CARE ONE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-409-4111
Mailing Address - Street 1:1100 W MONROE AVE APT 145
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2967
Mailing Address - Country:US
Mailing Address - Phone:702-409-4111
Mailing Address - Fax:
Practice Address - Street 1:1100 W MONROE AVE APT 145
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2967
Practice Address - Country:US
Practice Address - Phone:702-409-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2600165361OtherDRIVERS LICENSE