MEDICARE: DE CRAIG RANCH, 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	282N00000X	General Acute Care Hospital

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	290058	OTHER	NV	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578007514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DE CRAIG RANCH, LLC

Provider Business Mailing Address
First Line	:	8686 NEW TRAILS DR
Second Line	:	SUITE 100
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-1176
Country	:	US
Telephone Number	:	713-637-1146
Fax Number	:	281-298-5311

Provider Business Practice Location Address
First Line	:	1550 W CRAIG RD STE 100
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0224
Country	:	US
Telephone Number	:	702-777-3615
Fax Number	:	702-642-0808

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN BUCK
Credential	:
Telephone Number	:	713-637-1004

Provider Enumeration Date	:	12/09/2016
Last Update Date	:	09/28/2021

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Directions to “DE CRAIG RANCH, LLC ” Practice Location

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