Provider Demographics
NPI:1841541620
Name:180 COMMUNITY WELLNESS CENTERS, LLC
Entity type:Organization
Organization Name:180 COMMUNITY WELLNESS CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEVERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-675-6314
Mailing Address - Street 1:3435 W. CRAIG ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5116
Mailing Address - Country:US
Mailing Address - Phone:702-675-6314
Mailing Address - Fax:702-476-9697
Practice Address - Street 1:3435 W. CRAIG ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5116
Practice Address - Country:US
Practice Address - Phone:702-675-6314
Practice Address - Fax:702-476-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5901-C251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health