MEDICARE: DANIEL ALEXANDER LLC

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	311ZA0620X	Adult Care Home Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9793-AGC	OTHER	NV	NV DEPT HEALTH & HUMAN SERVICES / DIV OF PUBLIC & BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1417594284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL ALEXANDER LLC

Provider Business Mailing Address
First Line	:	508 PEARBERRY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7219
Country	:	US
Telephone Number	:	702-897-0925
Fax Number	:	702-897-0926

Provider Business Practice Location Address
First Line	:	508 PEARBERRY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7219
Country	:	US
Telephone Number	:	702-897-0925
Fax Number	:	702-897-0926

Authorized Official
Title or Position	:	MEMBER / FACILITY MANAGER
Name	:	ROY DEGUZMAN DESAMITO
Credential	:
Telephone Number	:	702-897-0925

Provider Enumeration Date	:	11/29/2019
Last Update Date	:	11/29/2019

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