MEDICARE: FAITH SHARI ADULT CARE II

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	320700000X	Physical Disabilities Residential Treatment Facility	NV20111151465	NV

General Provider Information

NPI Number	:	1023437100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH SHARI ADULT CARE II

Provider Business Mailing Address
First Line	:	6215 E OWENS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-1802
Country	:	US
Telephone Number	:	702-856-6443
Fax Number	:

Provider Business Practice Location Address
First Line	:	6215 E OWENS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-1802
Country	:	US
Telephone Number	:	702-856-6443
Fax Number	:

Authorized Official
Title or Position	:	RFA/OWNER
Name	:	FAITH SHARI RAMOS
Credential	:	RFA
Telephone Number	:	702-856-6443

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	04/16/2014

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