Healthcare Provider Details

I. General information

NPI: 1104253905
Provider Name (Legal Business Name): MARY JEWELS HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2013
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 CANARY WAY
LAS VEGAS NV
89106-1912
US

IV. Provider business mailing address

2224 CANARY WAY
LAS VEGAS NV
89106
US

V. Phone/Fax

Practice location:
  • Phone: 702-201-8585
  • Fax:
Mailing address:
  • Phone: 702-201-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberEO4373920119
License Number StateNV

VIII. Authorized Official

Name: JEWEL DEGUZMAN
Title or Position: OWNER
Credential:
Phone: 702-201-8585