Provider Demographics
NPI:1871178574
Name:FAMILY FIRST WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:FAMILY FIRST WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW-RANSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-884-0233
Mailing Address - Street 1:304 S JONES BLVD # 7115
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2623
Mailing Address - Country:US
Mailing Address - Phone:702-884-0233
Mailing Address - Fax:
Practice Address - Street 1:1011 VILLA GROVE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-4706
Practice Address - Country:US
Practice Address - Phone:702-626-0015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadoneGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20191241196OtherBUSINESS IDENIFIVATION NUMBER