Provider Demographics
NPI:1255920401
Name:W.B. WELLNESS L.L.C.
Entity type:Organization
Organization Name:W.B. WELLNESS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WANYA
Authorized Official - Middle Name:DIJON
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-619-9554
Mailing Address - Street 1:7347 CHARRO CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89179-1239
Mailing Address - Country:US
Mailing Address - Phone:702-619-9554
Mailing Address - Fax:
Practice Address - Street 1:7347 CHARRO CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89179-1239
Practice Address - Country:US
Practice Address - Phone:702-619-9554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)