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NPI Code Detail

MEDICARE: ASSERTIVE LIVING

MEDICARE: ASSERTIVE LIVING
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
1320800000XMental Illness Community Based Residential Treatment FacilityNV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073750626
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASSERTIVE LIVING
Provider Business Mailing Address
First Line : 1350 E FLAMINGO RD
Second Line : BOX 577
City : LAS VEGAS
State : NV
Zip : 89119-5263
Country : US
Telephone Number : 702-202-2902
Fax Number : 702-202-6551
Provider Business Practice Location Address
First Line : 3430 E FLAMINGO RD
Second Line : STE 220
City : LAS VEGAS
State : NV
Zip : 89121-5003
Country : US
Telephone Number : 702-202-2902
Fax Number : 702-202-6551
Authorized Official
Title or Position : PRESIDENT AND CEO
Name : MR. VICTOR C SUTTON
Credential : M.S.W.
Telephone Number : 702-302-1105
Provider Enumeration Date : 01/18/2009
Last Update Date : 06/21/2011

Similar Medicare Providers

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Practice Location Address:
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1962706291 — STACY SPANN QBA
Practice Location Address:
3430 E FLAMINGO RD , SUITE 237
LAS VEGAS, NV
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Practice Fax: 702-483-6288
1598069825 — BRANDON GARNETT QBA
Practice Location Address:
3430 E FLAMINGO RD , SUITE 220
LAS VEGAS, NV
89121-5003
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Practice Fax: 702-202-6551
1053615385 — MARDA PEARSON QBA
Practice Location Address:
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1225332554 — TALISHIA TURNER
Practice Location Address:
3430 E FLAMINGO RD , SUITE 237
LAS VEGAS, NV
89121-5003
Practice Phone: 702-834-5849
Practice Fax: 702-483-6288

Directions to “ASSERTIVE LIVING ” Practice Location

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