Provider Demographics
NPI:1528431277
Name:CORRIDOR OF HOPE WELLNESS & CONSULTING, LLC
Entity type:Organization
Organization Name:CORRIDOR OF HOPE WELLNESS & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-379-4260
Mailing Address - Street 1:1830 E SAHARA AVE
Mailing Address - Street 2:103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3737
Mailing Address - Country:US
Mailing Address - Phone:702-370-2960
Mailing Address - Fax:702-543-1777
Practice Address - Street 1:1830 E SAHARA AVE
Practice Address - Street 2:103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3737
Practice Address - Country:US
Practice Address - Phone:702-370-2960
Practice Address - Fax:702-543-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20151521890251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1447644067Medicaid