MEDICARE: FJR CARE SERVICES LLC

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1023361193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FJR CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	2422 SWIFTON CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5074
Country	:	US
Telephone Number	:	702-421-2071
Fax Number	:	702-421-2785

Provider Business Practice Location Address
First Line	:	2422 SWIFTON CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5074
Country	:	US
Telephone Number	:	702-421-2071
Fax Number	:	702-421-2785

Authorized Official
Title or Position	:	MANAGER
Name	:	JOSEPH RUEDA
Credential	:
Telephone Number	:	702-421-2073

Provider Enumeration Date	:	10/25/2012
Last Update Date	:	10/25/2012

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