| 1 Love Wellness Society Llc | |
|
5940 S Rainbow Blvd Ste 213 Rm 1014 Las Vegas NV 89118-2506 | |
| (562) 714-2146 | |
| Not Available |
| Full Name | 1 Love Wellness Society Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5940 S Rainbow Blvd Ste 213, Las Vegas, Nevada |
| Authorized Official Name and Position | Denise Madison (OWNER) |
| Authorized Official Contact | 5627142146 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 1 Love Wellness Society Llc 5940 S Rainbow Blvd Ste 213 Rm 1014 Las Vegas NV 89118-2506 Ph: (562) 714-2146 | 1 Love Wellness Society Llc 5940 S Rainbow Blvd Ste 213 Rm 1014 Las Vegas NV 89118-2506 Ph: (562) 714-2146 |
| NPI Number | 1235677477 |
|---|---|
| Provider Enumeration Date | 02/08/2017 |
| Last Update Date | 09/03/2021 |
| Certification Date | 09/03/2021 |
| Medicare PECOS PAC ID | 4789081530 |
|---|---|
| Medicare Enrollment ID | O20210922000917 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235677477 | NPI | - | NPPES |
| Provider Name | Sean Elder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770997926 PECOS PAC ID: 3678794328 Enrollment ID: I20141021002070 |
| Provider Name | Dominique Roumain |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144570078 PECOS PAC ID: 6103064407 Enrollment ID: I20220811003111 |
| Provider Name | Wyatt Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598462533 PECOS PAC ID: 5597139543 Enrollment ID: I20230315000558 |
| Provider Name | Martin Louis Apt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336839364 PECOS PAC ID: 2062874548 Enrollment ID: I20230815003781 |
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