MEDICARE: REHAB DIRECTIVES 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	261QM1300X	Multi-Specialty Clinic/Center	NV201111577957	NV

General Provider Information

NPI Number	:	1477062065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHAB DIRECTIVES LLC

Provider Business Mailing Address
First Line	:	3213 W CHARLESTON BLVD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1991
Country	:	US
Telephone Number	:	17025706222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2860 E CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4234
Country	:	US
Telephone Number	:	702-570-6222
Fax Number	:	702-224-2165

Authorized Official
Title or Position	:	MANAGER
Name	:	DAVID W GILBERT
Credential	:
Telephone Number	:	702-767-3177

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	09/26/2017

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