Healthcare Provider Details

I. General information

NPI: 1538614961
Provider Name (Legal Business Name): AMERICAN SENIOR HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 E WINDMILL LN
LAS VEGAS NV
89123-1716
US

IV. Provider business mailing address

185 E WINDMILL LN
LAS VEGAS NV
89123-1716
US

V. Phone/Fax

Practice location:
  • Phone: 702-444-0792
  • Fax:
Mailing address:
  • Phone: 702-403-3661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number8576-AGC-0
License Number StateNV

VIII. Authorized Official

Name: ISAAC FARAH
Title or Position: MEMBER
Credential:
Phone: 702-403-3661