| Primewell Solutions Behavioral Health Llc | |
|
421 S Decatur Blvd Las Vegas NV 89107-2812 | |
| (702) 462-2325 | |
| Not Available |
| Full Name | Primewell Solutions Behavioral Health Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 421 S Decatur Blvd, Las Vegas, Nevada |
| Authorized Official Name and Position | Jose Antonio Diago (MANAGING MEMBER) |
| Authorized Official Contact | 7023508216 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primewell Solutions Behavioral Health Llc 6385 Black Swan Ln Las Vegas NV 89118-1998 Ph: () - | Primewell Solutions Behavioral Health Llc 421 S Decatur Blvd Las Vegas NV 89107-2812 Ph: (702) 462-2325 |
| NPI Number | 1689426553 |
|---|---|
| Provider Enumeration Date | 04/03/2024 |
| Last Update Date | 10/01/2024 |
| Certification Date | 10/01/2024 |
| Medicare PECOS PAC ID | 5597205914 |
|---|---|
| Medicare Enrollment ID | O20240911003117 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689426553 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Brenda Gaile Primero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831613025 PECOS PAC ID: 7618241670 Enrollment ID: I20170914003555 |
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