MEDICARE: PEARL SENIOR LIVING, INC.

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

General Provider Information

NPI Number	:	1487420584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARL SENIOR LIVING, INC.

Provider Business Mailing Address
First Line	:	3985 S PEARL ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3985 S PEARL ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7205
Country	:	US
Telephone Number	:	702-706-0036
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	AMBER TUELLER
Credential	:
Telephone Number	:	208-401-1369

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	11/19/2025

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