Provider Demographics
NPI:1104589266
Name:FJW INCORPORATED
Entity type:Organization
Organization Name:FJW INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-762-2592
Mailing Address - Street 1:2870 S MARYLAND PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1548
Mailing Address - Country:US
Mailing Address - Phone:702-330-0530
Mailing Address - Fax:702-476-9930
Practice Address - Street 1:2870 S MARYLAND PKWY STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1548
Practice Address - Country:US
Practice Address - Phone:702-330-0530
Practice Address - Fax:702-476-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250016271Medicaid