Chanel Willis – Rehabilitation Practitioner in NV, NV

Key facts

NPI: 1821334384
Entity type: Individual (NPI type 1)
Primary specialty: Rehabilitation Practitioner 225400000X
Practice address: 224 S. Jones LV NV
NV, NV 89107
Phone: (702) 822-1206
Fax: (702) 822-1124
NPI assigned: Jan 2, 2013
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

New Foundations Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Las Vegas, NV · NPI 1225467103

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Practice roles

Organization	Specialty	Status	New patients
New Foundations		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Rehabilitation Practitioner	225400000X			Yes

Addresses

Primary practice location

224 S. Jones LV NV
NV, NV 89107

Mailing address

224 S. Jones LV NV
NV, NV 89107
Phone (702) 822-1206

Other providers in NV, NV

Jose Antonio Ortega

All providers in NV, NV · Rehabilitation Practitioner in Nevada

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2013. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.