Provider Demographics
NPI:1144728403
Name:WELLNESS REJUVENATION CENTER
Entity type:Organization
Organization Name:WELLNESS REJUVENATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:TASHI
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-476-9700
Mailing Address - Street 1:311 N BUFFALO DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-0375
Mailing Address - Country:US
Mailing Address - Phone:702-476-9700
Mailing Address - Fax:702-476-9138
Practice Address - Street 1:311 N BUFFALO DR STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0375
Practice Address - Country:US
Practice Address - Phone:702-476-9700
Practice Address - Fax:702-476-9138
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR WELLNESS AND PAIN CARE OF LAS VEGAS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain