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NPI Code Detail

MEDICARE: TANCELL CARE LLC

MEDICARE: TANCELL CARE 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
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment Facility
2261QD1600XDevelopmental Disabilities Clinic/Center

General Provider Information

NPI Number : 1669032546
Entity Type Code : Organization
Provider Name (Legal Business Name) : TANCELL CARE LLC
Provider Business Mailing Address
First Line : 1500 E TROPICANA AVE STE 248
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-8325
Country : US
Telephone Number : 702-882-4975
Fax Number :
Provider Business Practice Location Address
First Line : 4000 S EASTERN AVE STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0840
Country : US
Telephone Number : 702-476-0262
Fax Number : 702-441-0466
Authorized Official
Title or Position : CEO
Name : LOUIE NOVELO CELLONA
Credential :
Telephone Number : 702-476-0262
Provider Enumeration Date : 06/13/2019
Last Update Date : 02/07/2023

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Directions to “TANCELL CARE LLC ” Practice Location

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