MEDICARE: EXDOUS FAMILY & GUIDANCE COALITION LLC

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	305S00000X	Point of Service	NV20131436018	NV

General Provider Information

NPI Number	:	1205268695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXDOUS FAMILY & GUIDANCE COALITION LLC

Provider Business Mailing Address
First Line	:	1415 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3311
Country	:	US
Telephone Number	:	702-569-4455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3311
Country	:	US
Telephone Number	:	702-569-4455
Fax Number	:

Authorized Official
Title or Position	:	PART OWNER
Name	:	MYRNA PILI
Credential	:
Telephone Number	:	702-569-4455

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	08/07/2013

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