MEDICARE: TTF GROUP DBA PLAXIA CARE

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	311500000X	Alzheimer Center (Dementia Center)
2	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1467126391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TTF GROUP DBA PLAXIA CARE

Provider Business Mailing Address
First Line	:	5095 N PARK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-2522
Country	:	US
Telephone Number	:	702-858-4559
Fax Number	:

Provider Business Practice Location Address
First Line	:	5095 N PARK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-2522
Country	:	US
Telephone Number	:	702-858-4559
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. NICHOLE R CROCK
Credential	:	RFA
Telephone Number	:	702-858-4559

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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