MEDICARE: DELALI MANAGEMENT SERVICES

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	104100000X	Social Worker	5116S	NV
2	261QC1500X	Community Health Clinic/Center
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1023449089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELALI MANAGEMENT SERVICES

Provider Business Mailing Address
First Line	:	6121 MEADOW VIEW LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1121
Country	:	US
Telephone Number	:	702-806-9143
Fax Number	:	186-628-0947

Provider Business Practice Location Address
First Line	:	2585 S JONES BLVD STE 2F
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5604
Country	:	US
Telephone Number	:	702-806-9143
Fax Number	:	186-628-0947

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/OWNER
Name	:	DR. AYELE E AMAVIGAN
Credential	:	ED.D, MSW, LCSW
Telephone Number	:	702-806-9143

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	08/01/2022

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