MEDICARE: AMERICAN SENIOR HOME 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	311500000X	Alzheimer Center (Dementia Center)	8576-AGC-0	NV

General Provider Information

NPI Number	:	1538614961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN SENIOR HOME LLC

Provider Business Mailing Address
First Line	:	185 E WINDMILL LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1716
Country	:	US
Telephone Number	:	702-403-3661
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 E WINDMILL LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1716
Country	:	US
Telephone Number	:	702-444-0792
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ISAAC FARAH
Credential	:
Telephone Number	:	702-403-3661

Provider Enumeration Date	:	08/15/2016
Last Update Date	:	08/15/2016

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