MEDICARE: AZURE GROUP HOME

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	251S00000X	Community/Behavioral Health Agency	98459865401	NV

General Provider Information

NPI Number	:	1407932569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZURE GROUP HOME

Provider Business Mailing Address
First Line	:	4180 S PECOS RD STE 115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5075
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4180 S PECOS RD STE 115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5075
Country	:	US
Telephone Number	:	702-433-5368
Fax Number	:	702-434-2485

Authorized Official
Title or Position	:	PRESIDENT/MANAGER
Name	:	YELENA YEKTA
Credential	:
Telephone Number	:	702-433-5368

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	08/22/2020

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