MEDICARE: A PRECIOUS GEMS 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	311ZA0620X	Adult Care Home Facility	3171-AGC-20	NV

General Provider Information

NPI Number	:	1053827212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PRECIOUS GEMS LLC

Provider Business Mailing Address
First Line	:	695 LYNMAR CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-8751
Country	:	US
Telephone Number	:	702-218-3319
Fax Number	:

Provider Business Practice Location Address
First Line	:	1733 HUNTERS BLUFF DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-7983
Country	:	US
Telephone Number	:	702-636-5501
Fax Number	:

Authorized Official
Title or Position	:	FACILITY MANAGER/OWNER
Name	:	RAYMOND AQUINO TORIO
Credential	:
Telephone Number	:	702-218-3319

Provider Enumeration Date	:	12/22/2017
Last Update Date	:	12/22/2017

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