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NPI Code Detail

MEDICARE: DARK KNIGHT TRUST

MEDICARE: DARK KNIGHT TRUST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorNV20121035663NV
2246Y00000XHealth Information Specialist/Technologist
3253Z00000XIn Home Supportive Care AgencyNV20121035663NV
4311Z00000XCustodial Care FacilityNV20121035663NV
5343900000XNon-emergency Medical Transport (VAN)NV20121035663NV
6374U00000XHome Health AideNV20121035663NV
7251B00000XCase Management AgencyNV20121035663NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NV20121035663OTHERNVSTATE OF NEVADA

General Provider Information

NPI Number : 1003246612
Entity Type Code : Organization
Provider Name (Legal Business Name) : DARK KNIGHT TRUST
Provider Business Mailing Address
First Line : 840 S RANCHO DR
Second Line : SUITE 4-410
City : LAS VEGAS
State : NV
Zip : 89106-3837
Country : US
Telephone Number : 702-754-5700
Fax Number : 702-982-8762
Provider Business Practice Location Address
First Line : 840 S RANCHO DR
Second Line : SUITE 4-410
City : LAS VEGAS
State : NV
Zip : 89106-3837
Country : US
Telephone Number : 702-754-5700
Fax Number : 702-982-8762
Authorized Official
Title or Position : CFO/COO
Name : MR. THERON WARD
Credential :
Telephone Number : 702-754-5701
Provider Enumeration Date : 11/18/2013
Last Update Date : 11/18/2013

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Directions to “DARK KNIGHT TRUST ” Practice Location

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