Provider Demographics
NPI:1104667724
Name:COMMUNITY OF HOPE & WELLNESS
Entity type:Organization
Organization Name:COMMUNITY OF HOPE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FUNCHESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-665-2021
Mailing Address - Street 1:5297 SILVERHEART AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-0167
Mailing Address - Country:US
Mailing Address - Phone:702-665-2021
Mailing Address - Fax:
Practice Address - Street 1:5297 SILVERHEART AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-0167
Practice Address - Country:US
Practice Address - Phone:702-665-2021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health