Provider Demographics
NPI:1194441857
Name:ROSE WELLNESS LV LLC
Entity type:Organization
Organization Name:ROSE WELLNESS LV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-355-3900
Mailing Address - Street 1:8550 W CHARLESTON BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9080
Mailing Address - Country:US
Mailing Address - Phone:725-210-4900
Mailing Address - Fax:
Practice Address - Street 1:8550 W CHARLESTON BLVD STE 108
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-9080
Practice Address - Country:US
Practice Address - Phone:725-210-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty