MEDICARE: AVALON & BEYOND, 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	311500000X	Alzheimer Center (Dementia Center)	1934AGZ-11	NV

General Provider Information

NPI Number	:	1336352574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVALON & BEYOND, INC.

Provider Business Mailing Address
First Line	:	7450 DEL REY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1409
Country	:	US
Telephone Number	:	702-240-6102
Fax Number	:	702-240-6104

Provider Business Practice Location Address
First Line	:	7450 DEL REY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1409
Country	:	US
Telephone Number	:	702-240-6102
Fax Number	:	702-240-6104

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS LILIA SIOSON
Credential	:
Telephone Number	:	702-240-6102

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	08/22/2020

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