Provider Demographics
NPI:1073342390
Name:ADVANCED CARE & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:ADVANCED CARE & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMPAL-WHETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-285-1185
Mailing Address - Street 1:1098 ASPEN BREEZE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3195
Mailing Address - Country:US
Mailing Address - Phone:702-591-3381
Mailing Address - Fax:
Practice Address - Street 1:855 E TWAIN AVE STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-0820
Practice Address - Country:US
Practice Address - Phone:702-591-3381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty