MEDICARE: THE PROMISE FOSTERCARE AGENCY

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
1	251T00000X	PACE Provider Organization		NV

General Provider Information

NPI Number	:	1023288875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PROMISE FOSTERCARE AGENCY

Provider Business Mailing Address
First Line	:	6008 FLY FISHER ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1728
Country	:	US
Telephone Number	:	702-655-5332
Fax Number	:

Provider Business Practice Location Address
First Line	:	6008 FLY FISHER ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1728
Country	:	US
Telephone Number	:	702-655-5332
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	VERNASSA WILLIAMS
Credential	:
Telephone Number	:	702-655-5332

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	03/07/2008

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Directions to “THE PROMISE FOSTERCARE AGENCY ” Practice Location

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