Healthcare Provider Details

I. General information

NPI: 1851581912
Provider Name (Legal Business Name): SHEPHERDS FOR SENIORS OF NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MOUNT VERNON CIR UNIT B
LAS VEGAS NV
89101-1009
US

IV. Provider business mailing address

104 MOUNT VERNON CIR UNIT B
LAS VEGAS NV
89101-1009
US

V. Phone/Fax

Practice location:
  • Phone: 702-604-9187
  • Fax:
Mailing address:
  • Phone: 702-604-9187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNV

VIII. Authorized Official

Name: MR. CHRISTOPHER M JONES
Title or Position: PRESIDENT
Credential:
Phone: 702-604-9187