Healthcare Provider Details

I. General information

NPI: 1518209329
Provider Name (Legal Business Name): ST JEAN SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6924 ACOMA CT
LAS VEGAS NV
89145-5305
US

IV. Provider business mailing address

6924 ACOMA CT
LAS VEGAS NV
89145-5305
US

V. Phone/Fax

Practice location:
  • Phone: 702-489-9297
  • Fax:
Mailing address:
  • Phone: 702-489-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number5936AGZ-2
License Number StateNV

VIII. Authorized Official

Name: MR. ROBERT ILAGAN ST JEAN
Title or Position: OWNER
Credential:
Phone: 702-489-9297