Healthcare Provider Details

I. General information

NPI: 1811353576
Provider Name (Legal Business Name): LIFESHARE CARE HOME NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7925 W ROSADA WAY
LAS VEGAS NV
89149-5208
US

IV. Provider business mailing address

2795 GEORGE BLAUER PL
SAN JOSE CA
95135-1281
US

V. Phone/Fax

Practice location:
  • Phone: 702-722-6783
  • Fax: 702-998-0280
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number6087AGC-6
License Number StateNV

VIII. Authorized Official

Name: BELINDA DEVANO
Title or Position: PRESIDENT/ADMINISTRATOR
Credential:
Phone: 408-854-0735