MEDICARE: ELKHORN JONES MEMORY CARE 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
1	311500000X	Alzheimer Center (Dementia Center)

General Provider Information

NPI Number	:	1275198749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELKHORN JONES MEMORY CARE LLC

Provider Business Mailing Address
First Line	:	6017 ELKHORN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3019
Country	:	US
Telephone Number	:	702-444-4062
Fax Number	:	702-778-6831

Provider Business Practice Location Address
First Line	:	6017 ELKHORN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3019
Country	:	US
Telephone Number	:	702-444-4062
Fax Number	:	702-778-6831

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NICHOLE CROCK
Credential	:	RFA
Telephone Number	:	702-858-4559

Provider Enumeration Date	:	05/09/2019
Last Update Date	:	04/21/2020

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