MEDICARE: AS TIME GOES BY

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	311500000X	Alzheimer Center (Dementia Center)

General Provider Information

NPI Number	:	1063071728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AS TIME GOES BY

Provider Business Mailing Address
First Line	:	4125 N BUTLER ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-4864
Country	:	US
Telephone Number	:	702-655-5557
Fax Number	:	702-655-2743

Provider Business Practice Location Address
First Line	:	4149 JORY TRL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-5206
Country	:	US
Telephone Number	:	702-655-7175
Fax Number	:	702-655-7175

Authorized Official
Title or Position	:	ADMINISTRATOR, OWNER
Name	:	MRS. JUNE KERN
Credential	:	RN
Telephone Number	:	702-683-4568

Provider Enumeration Date	:	06/06/2019
Last Update Date	:	06/06/2019

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