MEDICARE: HENDERSON SENIOR LIVING

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	:	1275380990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENDERSON SENIOR LIVING

Provider Business Mailing Address
First Line	:	2690 CELEBRATE CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-6997
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2690 CELEBRATE CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-6997
Country	:	US
Telephone Number	:	725-780-1089
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	CRISTINA LAZAR
Credential	:
Telephone Number	:	702-235-2584

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	05/01/2024

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Directions to “HENDERSON SENIOR LIVING ” Practice Location

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