MEDICARE: GRIFFITH GROUP HOME

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1952739161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRIFFITH GROUP HOME

Provider Business Mailing Address
First Line	:	5866 CALVERTS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1518
Country	:	US
Telephone Number	:	775-843-1138
Fax Number	:	702-645-2818

Provider Business Practice Location Address
First Line	:	5866 CALVERTS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1518
Country	:	US
Telephone Number	:	775-843-1138
Fax Number	:	702-645-2818

Authorized Official
Title or Position	:	DIRECTOR7758431138
Name	:	FALLON GRIFFITH
Credential	:
Telephone Number	:	775-843-1138

Provider Enumeration Date	:	10/24/2013
Last Update Date	:	10/24/2013

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Directions to “GRIFFITH GROUP HOME ” Practice Location

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