MEDICARE: GREEN VALLEY MEMORY CARE

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1184332959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN VALLEY MEMORY CARE

Provider Business Mailing Address
First Line	:	2321 THAYER AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5367
Country	:	US
Telephone Number	:	702-476-8588
Fax Number	:

Provider Business Practice Location Address
First Line	:	2321 THAYER AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5367
Country	:	US
Telephone Number	:	702-476-8588
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANALYN LUA DIAZ
Credential	:
Telephone Number	:	702-863-6095

Provider Enumeration Date	:	11/10/2022
Last Update Date	:	11/10/2022

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Directions to “GREEN VALLEY MEMORY CARE ” Practice Location

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