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General NPI Number Information
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NPI Number | 1336988732
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Entity Type | Individual
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Provider Name | SEVYN JACKSON
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Gender | Female
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Dates
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Enumeration Date | 05/23/2024
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 2033 RIDERWOOD AVE
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City | N LAS VEGAS
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State | NV
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Zip | 89032-0670
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Country | US
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Telephone | 310-216-8074
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Fax |
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Provider Business Mailing Address
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Address Line | 4612 CATFISH BEND RD
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City | N LAS VEGAS
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State | NV
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Zip | 89031-4242
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Country | US
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Telephone | 310-216-8074
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | NV20243092257
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License Number State | NV
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