MEDICARE: A LIST FAMILY SERVICES 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	320800000X	Mental Illness Community Based Residential Treatment Facility	6	NV

General Provider Information

NPI Number	:	1215228887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A LIST FAMILY SERVICES LLC

Provider Business Mailing Address
First Line	:	3481 E. SUNSET RD SUITE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3481 E. SUNSET RD SUITE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120
Country	:	US
Telephone Number	:	702-998-6264
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JR FONOTISATELE
Credential	:	BA
Telephone Number	:	702-998-6264

Provider Enumeration Date	:	04/29/2011
Last Update Date	:	07/21/2022

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