=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013615376
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AD4 ENTERPRISES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2023
-----------------------------------------------------
Last Update Date | 08/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2870 S MARYLAND PKWY STE 210
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89109-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-205-3382
-----------------------------------------------------
Fax | 702-405-6687
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2870 S MARYLAND PKWY STE 210
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89109-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-205-3382
-----------------------------------------------------
Fax | 702-405-6687
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | QUALITY MANAGEMENT
-----------------------------------------------------
Name | MISS ALEXIS L SEWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-858-0169
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------