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NPI Code Detail

MEDICARE: CHARLESTON RESIDENTIAL SERVICES LLC

MEDICARE: CHARLESTON RESIDENTIAL SERVICES 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
1311ZA0620XAdult Care Home Facility
2310400000XAssisted Living Facility

General Provider Information

NPI Number : 1083167290
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLESTON RESIDENTIAL SERVICES LLC
Provider Business Mailing Address
First Line : 840 S RANCHO DR # 4-613
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-3837
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2121 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2205
Country : US
Telephone Number : 702-382-7746
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. JEFFREY IVERSON
Credential :
Telephone Number : 702-357-8811
Provider Enumeration Date : 07/25/2016
Last Update Date : 07/25/2016

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Directions to “CHARLESTON RESIDENTIAL SERVICES LLC ” Practice Location

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