Provider Demographics
NPI:1871317149
Name:LAS VEGAS WELLNESS COLLECTIVE LLC
Entity type:Organization
Organization Name:LAS VEGAS WELLNESS COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JSHAUNTAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DOULA
Authorized Official - Phone:702-337-4793
Mailing Address - Street 1:8046 PAVAROTTI AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8264
Mailing Address - Country:US
Mailing Address - Phone:702-337-4793
Mailing Address - Fax:
Practice Address - Street 1:1230 W OWENS AVE STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2451
Practice Address - Country:US
Practice Address - Phone:702-703-4881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health Worker
No251B00000XAgenciesCase Management
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty