MEDICARE: GRACE CARE CENTER

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1407145998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE CARE CENTER

Provider Business Mailing Address
First Line	:	6915 E MESQUITE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-4112
Country	:	US
Telephone Number	:	702-300-7764
Fax Number	:	702-632-0878

Provider Business Practice Location Address
First Line	:	6915 E MESQUITE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-4112
Country	:	US
Telephone Number	:	702-300-7764
Fax Number	:	702-632-0878

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. EUDORA A MORDI
Credential	:
Telephone Number	:	702-300-7764

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/05/2011

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Directions to “GRACE CARE CENTER ” Practice Location

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