MEDICARE: NEVADA PRIME COMMODITIES 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1366602740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA PRIME COMMODITIES INC

Provider Business Mailing Address
First Line	:	4511 WILLOW TREE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2058
Country	:	US
Telephone Number	:	210-825-7641
Fax Number	:	210-481-2074

Provider Business Practice Location Address
First Line	:	4511 WILLOW TREE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2058
Country	:	US
Telephone Number	:	210-825-7641
Fax Number	:	210-481-2074

Authorized Official
Title or Position	:	MANAGER
Name	:	ARSENIO REYES
Credential	:
Telephone Number	:	210-825-7641

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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Directions to “NEVADA PRIME COMMODITIES INC ” Practice Location

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