MEDICARE: MIJN CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)	2000295.571	NV

General Provider Information

NPI Number	:	1043511132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIJN CORPORATION

Provider Business Mailing Address
First Line	:	3933 CAPTAIN JON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5024
Country	:	US
Telephone Number	:	702-457-1048
Fax Number	:

Provider Business Practice Location Address
First Line	:	3933 CAPTAIN JON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5024
Country	:	US
Telephone Number	:	702-457-1048
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL NARCISO
Credential	:
Telephone Number	:	702-334-2273

Provider Enumeration Date	:	11/05/2010
Last Update Date	:	11/05/2010

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Directions to “MIJN CORPORATION ” Practice Location

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