=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952706913
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JTR HEALTHCARE SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2014
-----------------------------------------------------
Last Update Date | 06/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2320 PASEO DEL PRADO SUITE B307
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89102-0048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-628-8423
-----------------------------------------------------
Fax | 702-834-4848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2320 PASEO DEL PRADO SUITE B307
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89102-4358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-628-8423
-----------------------------------------------------
Fax | 702-834-4848
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ROMEO ABETO SEDANO JR.
-----------------------------------------------------
Credential | BS MANAGEMENT
-----------------------------------------------------
Telephone | 702-628-8423
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | NV20131251195
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------