Healthcare Provider Details

I. General information

NPI: 1942055058
Provider Name (Legal Business Name): DWC TRANSITION LIVING L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 EL CAMINO AVE
LAS VEGAS NV
89102-3601
US

IV. Provider business mailing address

4021 EL CAMINO AVE
LAS VEGAS NV
89102-3601
US

V. Phone/Fax

Practice location:
  • Phone: 702-289-3688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN HILL SR.
Title or Position: MANAGER
Credential:
Phone: 70-284-3869