MEDICARE: ASSEFA GETACHEW ASEMAHEGN

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	11211-AGC-0	NV

General Provider Information

NPI Number	:	1427843143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASSEFA GETACHEW ASEMAHEGN

Provider Business Mailing Address
First Line	:	1733 HUNTERS BLUFF DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-7983
Country	:	US
Telephone Number	:	702-824-0019
Fax Number	:	702-268-8686

Provider Business Practice Location Address
First Line	:	1733 HUNTERS BLUFF DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-7983
Country	:	US
Telephone Number	:	702-824-0019
Fax Number	:	702-268-8686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2025
Last Update Date	:	12/13/2025

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