=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336598333
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOSPITALITY HOUSEKEEPING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2016
-----------------------------------------------------
Last Update Date | 06/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2697 AARONDAVID DR APARTMENT B
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89121-7552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-664-0463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2697 AARONDAVID DR APARTMENT B
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89121-7552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMIE BENGUCHE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-664-0463
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320700000X
-----------------------------------------------------
Taxonomy Name | Physical Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | 1603490224
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------