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General NPI Number Information
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NPI Number | 1871907386
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Entity Type | Organization
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Legal Business Name | EVENING STAR ASSISTED LIVING LLC
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 06/12/2014
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Provider Practice Location Address
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Address Line | 993 COLDWATER FALLS WAY
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City | LAS VEGAS
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State | NV
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Zip | 89123-4803
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Country | US
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Telephone | 702-981-9831
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Fax |
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Provider Business Mailing Address
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Address Line | 993 COLDWATER FALLS WAY
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City | LAS VEGAS
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State | NV
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Zip | 89123-4803
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Country | US
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Telephone | 702-981-9831
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | HOLLY ERIN HOFFMAN
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Credential |
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Telephone | 702-891-9831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 7849PCS-0
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License Number State | NV
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