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NPI Code Detail

MEDICARE: ACCESSIBLE SPACE INC.

MEDICARE: ACCESSIBLE SPACE 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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1285252742
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACCESSIBLE SPACE INC.
Provider Business Mailing Address
First Line : 6375 W CHARLESTON BLVD BLDG L
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-1139
Country : US
Telephone Number : 702-259-1903
Fax Number :
Provider Business Practice Location Address
First Line : 3209 CEDAR ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-4472
Country : US
Telephone Number : 702-431-0672
Fax Number : 702-431-0673
Authorized Official
Title or Position : DIRECTOR
Name : JERRY KAPPELER
Credential :
Telephone Number : 702-259-1903
Provider Enumeration Date : 07/10/2020
Last Update Date : 07/10/2020

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