MEDICARE: MARY JEWELS HEALTH SERVICES INC

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	320700000X	Physical Disabilities Residential Treatment Facility	EO4373920119	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104253905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY JEWELS HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	2224 CANARY WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106
Country	:	US
Telephone Number	:	702-201-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	2224 CANARY WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-1912
Country	:	US
Telephone Number	:	702-201-8585
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEWEL DEGUZMAN
Credential	:
Telephone Number	:	702-201-8585

Provider Enumeration Date	:	10/11/2013
Last Update Date	:	10/11/2013

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Directions to “MARY JEWELS HEALTH SERVICES INC ” Practice Location

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