Healthcare Provider Details

I. General information

NPI: 1023437100
Provider Name (Legal Business Name): FAITH SHARI ADULT CARE II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 E OWENS AVE
LAS VEGAS NV
89110-1802
US

IV. Provider business mailing address

6215 E OWENS AVE
LAS VEGAS NV
89110-1802
US

V. Phone/Fax

Practice location:
  • Phone: 702-856-6443
  • Fax:
Mailing address:
  • Phone: 702-856-6443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberNV20111151465
License Number StateNV

VIII. Authorized Official

Name: FAITH SHARI RAMOS
Title or Position: RFA/OWNER
Credential: RFA
Phone: 702-856-6443