MEDICARE: SILVER HORIZON

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	8243AGC-2	NV

General Provider Information

NPI Number	:	1396190914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER HORIZON

Provider Business Mailing Address
First Line	:	8280 HICKAM AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-4847
Country	:	US
Telephone Number	:	702-413-8879
Fax Number	:

Provider Business Practice Location Address
First Line	:	8280 HICKAM AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-4847
Country	:	US
Telephone Number	:	702-413-8879
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PHILIP PRENTISS
Credential	:	MD
Telephone Number	:	702-413-8879

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	05/02/2016

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Directions to “SILVER HORIZON ” Practice Location

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