MEDICARE: SERVANT'S HEART COMMUNITY CARE 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
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1275370918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVANT'S HEART COMMUNITY CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	5550 PAINTED MIRAGE RD STE 320
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4584
Country	:	US
Telephone Number	:	702-800-9839
Fax Number	:	702-399-1827

Provider Business Practice Location Address
First Line	:	539 TERRACE POINT DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-1166
Country	:	US
Telephone Number	:	702-800-9839
Fax Number	:	702-399-1827

Authorized Official
Title or Position	:	CEO
Name	:	MR. ELLERY AARON RAYFORD
Credential	:
Telephone Number	:	702-800-9839

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	07/10/2024

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