Organization
LIFESTYLE REMEDIES WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE EAGLES (CEO)
(702) 680-5533
Entity
Organization
Contact information
Practice address
3646 LAS VEGAS BLVD N STE D, LAS VEGAS, NV 89115-1560
(702) 800-1932
Mailing address
6330 W AZURE DR, LAS VEGAS, NV 89130-7287
(702) 800-1932
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147032590
DRIVER LICENSE
NV
Enumeration date
10/24/2018
Last updated
10/24/2018
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