MEDICARE: SILVER HORIZON 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	253Z00000X	In Home Supportive Care Agency	7381AGC-3	NV

General Provider Information

NPI Number	:	1689059362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER HORIZON LLC

Provider Business Mailing Address
First Line	:	1900 ELIMINATOR DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1136
Country	:	US
Telephone Number	:	702-413-8879
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 ELIMINATOR DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1136
Country	:	US
Telephone Number	:	702-413-8879
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DEBRA LAUREL PETERSON
Credential	:
Telephone Number	:	702-413-8879

Provider Enumeration Date	:	07/23/2015
Last Update Date	:	07/23/2015

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