1578118717 NPI number — VEGAS WELLNESS TREATMENT CENTER

Table of content: TIMOTHY NEIL HOWARD BA (NPI 1699865071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578118717 NPI number — VEGAS WELLNESS TREATMENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VEGAS WELLNESS TREATMENT CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578118717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3920 W CHARLESTON BLVD STE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89102-1651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-478-2819
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3920 W CHARLESTON BLVD STE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89102-1651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-478-5541
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ALAGA
Authorized Official First Name:
IBIRONKE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
702-822-0447

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 786005 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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