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General NPI Number Information
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NPI Number | 1396512554
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Entity Type | Organization
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Legal Business Name | SHEPHERD CARE HOME CORP
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 5319 STAMPA AVE
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City | LAS VEGAS
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State | NV
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Zip | 89146-6853
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Country | US
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Telephone | 702-785-2812
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Fax |
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Provider Business Mailing Address
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Address Line | 3531 KAHALA BAY LN
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City | LAS VEGAS
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State | NV
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Zip | 89147-6511
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Country | US
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Telephone | 702-785-2812
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TESS PASCUAL
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Credential |
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Telephone | 702-785-2812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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