MEDICARE: SPRUCE OAK RESIDENTIAL CARE FACILITY

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	3104A0625X	Assisted Living Facility (Mental Illness)	5954AGC-10	NV

General Provider Information

NPI Number	:	1164825022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRUCE OAK RESIDENTIAL CARE FACILITY

Provider Business Mailing Address
First Line	:	4618 SPRUCE OAK DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0179
Country	:	US
Telephone Number	:	702-462-2031
Fax Number	:

Provider Business Practice Location Address
First Line	:	4618 SPRUCE OAK DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0179
Country	:	US
Telephone Number	:	702-462-2031
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MELISSA ST JEAN
Credential	:
Telephone Number	:	702-235-9644

Provider Enumeration Date	:	10/06/2014
Last Update Date	:	11/25/2014

Similar Medicare Providers

1528366887 — SORINA LAURA MESAROS
Practice Location Address:

4630 SPRUCE OAK DR
NORTH LAS VEGAS, NV
89031-0179

Practice Phone: 702-417-4339
Practice Fax:

1174821433 — OLIMPIU ADRIAN MESAROS
Practice Location Address:

4630 SPRUCE OAK DR
NORTH LAS VEGAS, NV
89031-0179

Practice Phone: 702-328-1454
Practice Fax:

1881751816 — VICTOR R HWANG D.M.D.
Practice Location Address:

5205 S DURANGO DR STE 103
LAS VEGAS, NV
89113-0179

Practice Phone: 702-384-2828
Practice Fax:

1881203230 — JAZMIN GUARDADO
Practice Location Address:

1490 S SLOAN LN
LAS VEGAS, NV
89142-0179

Practice Phone: 310-562-4860
Practice Fax:

1023738861 — HARMON AND OTTESON DENTAL DURANGO LLC
Practice Location Address:

5205 S DURANGO DR STE 103
LAS VEGAS, NV
89113-0179

Practice Phone: 765-669-1254
Practice Fax:

1053098947 — DR. CORY JOHN LANGE DMD
Practice Location Address:

5205 S DURANGO DR STE 103
LAS VEGAS, NV
89113-0179

Practice Phone: 702-384-2828
Practice Fax:

Directions to “SPRUCE OAK RESIDENTIAL CARE FACILITY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.