MEDICARE: OPEN HOUSE 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	1041C0700X	Clinical Social Worker	I-4116	NM

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	:	1831275536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN HOUSE LLC

Provider Business Mailing Address
First Line	:	1119 DOUGLAS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3932
Country	:	US
Telephone Number	:	505-718-6930
Fax Number	:	505-454-3803

Provider Business Practice Location Address
First Line	:	1119 DOUGLAS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3932
Country	:	US
Telephone Number	:	505-718-6930
Fax Number	:	505-454-3803

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	DEBORAH A. REUMANN
Credential	:	LISW
Telephone Number	:	505-718-6930

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	02/06/2008

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Directions to “OPEN HOUSE LLC ” Practice Location

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