MEDICARE: ARV NEVADA ASSISTED LIVING, INC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1194029025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARV NEVADA ASSISTED LIVING, INC

Provider Business Mailing Address
First Line	:	3250 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-0740
Country	:	US
Telephone Number	:	702-256-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-0740
Country	:	US
Telephone Number	:	702-256-6500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOHN MOORE
Credential	:
Telephone Number	:	502-779-7608

Provider Enumeration Date	:	01/07/2011
Last Update Date	:	01/07/2011

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